Editor’s note: The author has chosen to publish under an abbreviated version of her name in order to remain anonymous.Â
Iâm a licensed psychotherapist in private practice, currently training to become a psychoanalyst. Iâm married, am a parent, and was first diagnosed with borderline personality organization at the age of 23. Iâm now 49 years of age, and after 22 years of psychoanalysis that is still ongoing, 13 years of which I was heavily medicated on psychotropics, I am now medication free and am learning how to live and work with my personality âdisorderâ in a reflective, insightful and productive way. I no longer self-destruct through alcohol, pills, food, compulsive spending, or risky sexual behaviors. It is entirely possible to live and thrive as a âborderline personalityâ in this world.
My first psychotherapist diagnosed me with borderline personality disorder in 1998, but I wasnât fully aware that I had this personality organization until 2010, when I was 36. I was in my twelfth year of psychoanalysis at that time, two years into taking prescription psychotropics/mood stabilizers, and had spent the past 12 years going from different jobs, apartments, friendships and destructive, volatile romantic relationships, still also continuing to act out compulsively with food, exercise, spending, alcohol, and sex.
My âborderlineâ organization in those years frequently looked like this: if I woke up in the morning and felt a certain way, it was my belief that these feelings were reality, and that I then had every right to act on those feelings towards every person I encountered, no matter the consequence. I was volatile, self-absorbed, and narcissistic. I was also âthin-skinnedâ; meaning, I could not tolerate feedback of any kind, and if it was critical in any way, I would disintegrate emotionally. My husband was on the receiving end of most of these states, along with previous employers, friends and romantic partners. Our child was also beginning to feel my emotional lability more, and this, combined with the fact that I had a tremendous responsibility towards my patients, led me to go even deeper into my past with my analyst, and in particular, the lived and unlived lives of my parents, which I will outline below.
Born the youngest of four children, my father was a harsh, intense and brilliant man who had spent most of his adult life in chronic identity crises, which my mother, myself and my siblings were always in the middle of. My father had a successful business career but was drawn to religious sects and hobbies that, outside of his professional life, involved a great deal of emotional, mental and financial energy. My siblings and I were born and raised in a fundamentalist and cultlike religion for the first decade of our lives. My mother, an immigrant raised in poverty who only wanted to be taken care of by him, followed along with my fatherâs plans without any resistance, herself still a child, living in a perpetually narcissistic state that, much like my father, left her unavailable to us. Although my siblings and I were well cared for, we were highly controlled, and my fatherâs whims prevailed, first and foremost.
The religion we were raised in promoted severe corporal punishment, which meant that we were âdisciplinedâ by our father throughout our early and middle childhoods with vicious, anger-filled bare bottom spankings, along with ear pulling, and occasional facial slaps, always told by our father after these harsh and routine physical punishments, âI did this because I love you.â
My siblings and I internalized this sadomasochism, fear, crisis, punishment and anxiety as our relational templates from a young age, making shame and self-hatred the core of our inner lives, which were underneath the rage, anxiety and fear I constantly acted out and re-created in all aspects of my life and relationships.
I couldnât face what was given to me and then crucially, what was also within me (and everyone else), so I spent decades relentlessly judging and punishing myself for my feelings, especially those deemed ânegativeâ or repressed by my father, mother, and our high-control religion: rage, aggression, hatred, fear, which I gave to myself, and then everyone else, over and over again. After I would âact outâ my feelings, especially rage, the core feelings of shame and self-hatred would rear up within me even more intensely, especially as my loved ones would then understandably withdraw from me, which served as further âconfirmationâ that I was a horrible person that deserved only rejection and abandonment. I was repeating what had happened to me as a child, even though I was not aware of this at the time.
What helped me was that from a young age I displayed musical talent, so I began training as a classical musician, and then later, in my adolescence, began working in other artistic mediums along with classical music, which led to three years training at a prestigious Conservatory in Europe after I graduated college, where I also had my first analysis, free to all students who were full-time students. This analysis, along with living and training with other musicians and artists, saved me for a time, but things became more complicated when I also began to struggle with the highs and lows of bipolarity, experiencing my first manic break, and then psychiatry and medication.
I then had moderate success as a freelance performer, but the lifestyle was not a match for my sensitive and volatile nature, the rejection ruining me, mentally and emotionally. I craved stability, so I began mundane office work, eventually becoming a full-time executive assistant, which, financially and otherwise, gave me structure and allowed me to stay in analysis.
In the first decade or so of psychoanalysis, Iâd âsplitâ frequently on my analyst, moving with lightning speed between attacking him, then to remorse and sadness, and then right back to rage. I left him feeling tired, depleted and confused. When manic, I frequently left long, rambling messages on his voicemail service talking nonstop as my thoughts and emotions ricocheted from one end of my psyche to the other. Eventually I returned to psychiatry and medication, and through it all, my analyst kept containing my fragmented inner world, week after week.
After I first became aware of my âborderlineâ organization, I also tried to apply other modalities to my life in addition to analysis and medication; specifically, the 12 steps and Dialectical Behavioral Therapy (DBT). AA was effective in helping me stop my substance abuse issues, and I tolerated the spiritual aspects of the program because they were universal and non-punitive, unlike the religion of my childhood. I also had trouble maintaining friendships and romantic relationships, so sitting in meetings on the weekends and in the evenings after work gave me somewhere to go other than home to an empty apartment.
DBT, on the other hand, mystified me from the beginning, especially on a practical level, for as much as I understood the concepts, no matter how hard I tried to use the skills in my daily life, they didnât work. The skills felt abstract to me, and impossible to attain much less practice. I also resisted the terms âemotion regulationâ and âdistress tolerance,â for they routinely pathologized those of us in the skills group and individual coaching. Also, I intuitively knew that life was going to always have emotion and distress, even apart from my borderline organization, so wouldnât it make more sense for me to learn how to learn how to work with the emotion and distress, rather than to try to âregulateâ and âtolerateâ it (aka âmanageâ it)? DBT felt antithetical to my psychoanalysis and to helping me learn how to better integrate all the parts of myself, good and bad. I was repelled by it, and doubled down even more with my analyst.
After another depressive episode in 2012 which almost put me back in the hospital, things within me began to shift, at long last. I finally left office work to explore other kinds of work, which coincided with meeting and then marrying my husband. I then became pregnant, had a baby, and returned to graduate school one day a week, deciding to become a psychotherapist. Throughout all of the mayhem, madness and pain, I had discovered that sitting with other people, and listening to them, deeply, was invigorating, and also took me out of my own pain and suffering.
Even in the midst of so many destructive tendencies, I had always been intuitive and naturally analytical and curious about others, particularly children. I found through my own analysis that my sensitive, reactive and emotionally labile nature allowed me to naturally attune myself to others. My own suffering acted as a kind of light that illuminated for me other peopleâs pain and suffering, and I was more and more drawn to psychoanalytic theory and treatment as my analysis deepened, particularly with children and adolescents. These days I often think that when I work with children and adolescents, I can also repair my own childhood history of emotional, psychic neglect and isolation at the same time. As they heal in the treatment, I heal, too.
The nature of âborderlineâ organization can lack psychic momentum or growth, since the reenactments and splitting repeat themselves endlessly in all our interpersonal and clinical relationships. We live our lives spinning and descending in and out of emotional spirals, and we become static in this pattern, further entrenching our shame, fear, self-hatred, rage, and emotional lability. Whatâs more, these loops mimic our earliest primary relational patterns with parents and other family members, which we desperately want to heal from.
For me, I have found healing from these harrowing patterns by entering psychoanalysis, becoming a therapist, and then deciding to train as a psychoanalyst. Some days I still awake in terror, convinced that my husband, child or patients will really see how bad I am; that theyâll all leave me; that I am an imposter. These nameless, faceless fears, which are reverberations of the self-hatred and shame I was raised in, are easier to sit with now, since I now understand hatred and shame are a part of life, as is rage, fear, and feelings of inferiority. Compulsions, anxieties, depression, and mania are also a part of life, and are often normative reactions to a culture, society and world that is the most pathologizing time in history â and in this climate of emotional and psychic annihilation, these feelings become even more normal, and important, for they help us to make sense of how painful and challenging modern life has become.
Fundamentally, when these feelings now come, I can see that I am receiving more information about myself and the world, that I have more work to do, and even deeper still to go. I am intimate with the fear of living, and I am finding that this is a profound strength to have.
People labeled as âborderlineâ can transform our destruction, rage and fear into a force for good and transformation in the world.
My life is proof of that.
I have no doubt becoming a psychotherapist helped you. The question that is important related to what Mad in America covers is: how many patients did you harm subconsciously due to your unresolved issues?
I myself did a year of counseling training and it was helpful but also encouraged a kind of dissociation from deep feeling of emotions. If you’re a counselor that truly encourages that and deeply feels along with clients you’d be rare.
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I’m not one who enjoys typing with my thumbs and my accent plus my anxiety and delivery of speech prevent success with voice to text. In brevity, I applaud the author. The title of sensitivity, the only word I saw initially, led to my click on the story. The content led me to tears and a difficult time staying in the moment till it passes so I could continue reading. I used discretion and skipped your person history, as mine could interfere with my processing of the rest of the story which is remarkable. The last few bits, paragraphs beginning For me, and Fundamentally, read to me like an affirmation worth repeating.
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It does seem that child abuse, and a desire to quietly cover such up, is the primary etiology of most so called DSM “mental illnesses” today.
https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
https://www.madinamerica.com/2016/04/heal-for-life/
Which is a significant and systemic problem with the DSMs, since no “mental health” worker today, may ever honestly bill to help child abuse survivors.
https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1
Thank you for sharing your story, E. A., and I’m glad you’re doing better. But it is pretty pathetic that honestly discussing one’s history or concerns about child abuse, can NOT currently be honestly billed for, by our current “invalid,” paternalistic, DSM deluded “mental health” industries.
http://psychrights.org/2013/130429NIMHTransformingDiagnosis.htm
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I’ll keep my rage, destruction and fear. I’ve certainly earned them in spades after decades of abuse from the “mental health system”.
Borderline isn’t real. It’s a lie just like everything put forward by “experts.”
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I also think BPD is a made-up diagnosis designed mainly to label traumatized girls and women, like modern-day hysteria.
I want to live to see a time when BPD is no longer in diagnostic manuals or replaced by a similarly pejorative label. This label really doesn’t help anyone, it just ruins lives more.
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KateL,
Your anger and fear are healthy as they’re based in reality. Just don’t let them destroy you.
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Thanks, Birdsong.
I guess people who haven’t lived it don’t understand how awful it is having been sickened and demonized by a helping system and then spit out and left to fend completely alone with severe health problems and face the character attacks that never end. It’s easy to just say, “oh, borderline. Everyone knows what those are.”. Whatever.
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KateL,
It’s more than unfortunate that most people have no idea how harmful the “mental health” system actually is. And it’s very hurtful to be treated insensitively — especially by the people who work in “mental health” — when there’s not a lot you can do about it. So usually, the best thing to do is turn it around and say to yourself, “These people don’t know what they’re talking about and I’m not about to disturb my own peace of mind trying to change theirs.” Not easy, but it sure beats the alternative.
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Not to KL nor BS, but sometimes someone in the LOC actually might be drowning in their problems, like in fine grain stuff. And that could explain a lot of things. Not personal, but on the higher ups. The lower might try to protect or abuse the abscence of a head, a boss who’s actually there, or not.
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I enjoy reading this article. Thank you, E.A.! This is the first time I read about “borderline personality organization.” I am not sure what that is. Can someone explain?
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What should happen to people who were only ever offered drugs, ECT and DBT (coupled with constant abuse and neglect to the point they were left mentally and physically disabled) and then spit out of the system at middle aged, sick, alone, subsisting on disability checks and Medicare (no psychoanalysis, no actual health care, only more drugs) and have been rejected from any form of community, health care, job prospects – any sense of belonging? What should happen? Should they be judged endlessly for their “rage, fear and destruction” until they die alone? Should they be offered euthanasia? What should happen?
What should happen to people who’s only option is to “stay off the radar”? I do everything I can to stay off the radar. I don’t leave my apartment most of the time. I order shelf stable food online and hope the packages don’t get stolen, which is what happened yesterday.
What should happen to these “borderline personalities” who, as you suggest, are not fit to be in society, but for whom decades of psychoanalysis is not an option?
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I keep re-reading this essay in an effort to understand it, but every time I read it I have more questions.
You say,
“My first psychotherapist diagnosed me with borderline personality disorder in 1998, but I wasnât fully aware that I had this personality organization until 2010, when I was 36. I was in my twelfth year of psychoanalysis at that time, two years into taking prescription psychotropics/mood stabilizers, and had spent the past 12 years going from different jobs, apartments, friendships and destructive, volatile romantic relationships, still also continuing to act out compulsively with food, exercise, spending, alcohol, and sex”
Were you not told of the diagnosis or you were told but didn’t understand what it meant or understood what it meant but you didn’t believe it was a correct diagnosis?
How did the psych drugs play into your ability to function? This website is rife with evidence that psych drugs can cause all kinds of problems with functioning; if you were heavily medicated how do you know the psych drugs weren’t causing the problems you were having?
What drugs were you prescribed? Relevant because we are always told that “there is no drug for borderline “. What were you prescribed and what was the reasoning of the professional who prescribed the drugs?
I understand that MIA publishes a range of viewpoints but I feel like I have whiplash reading what MIA publishes about the borderline diagnosis. We go from “borderline personality has no place in clinical practice” to support for the therapists who reject patients with this diagnosis. From “no DSM diagnosis is real” to “here’s a new treatment that might help with the poor reflective functioning that people with borderline have.”. From suggesting that the diagnosis is misogynistic and should be thrown away to, just don’t diagnose people we consider to be marginalized with it.
There is no mention of trauma in the DSM definition of borderline. Is this article suggesting that borderline is something other than a trauma response?
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In my experience there is no simple answer to the complex and diversified issues of mental health. I believe that drilling down to the fundamentals is probably beyond both the desire and capability of most people. It is not an intellectual thing. It can take a person into some extremely dark and potentially very dangerous places where few are willing to go.
Instead we compromise with all sorts of theories, behaviours, therapies, diagnosis’s and even pharmaceuticals. All these things seem to help some people some of the time but don’t work at all for others. Nothing seems to work for everybody all of the time but almost anything will work for somebody sometimes.
This can be a hard idea for people to get their head around because most of us have been brought up in a pseudo scientific world where everything is supposed to have a cause and effect.
Sell your cleverness and buy bewilderment. Cleverness is mere opinion, bewilderment is intuition. -Rumi
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It could be concluded that some things working for some people some of the time suggests a weak causal effect.
From https://statisticsbyjim.com/basics/causation/
“If youâre only predicting events, not trying to understand why they happen, and do not want to alter the outcomes, correlation can be perfectly fine.” Treatment is an attempt at improving an outcome.
“When there is a real, causal connection, the result should be repeatable.”
“Statistical significance indicates that you have sufficient evidence to conclude that the relationship you observe in the sample also exists in the population.”
“Thatâs it. It doesnât address causality at all.”
Although it does mention: “Randomized experiments are the best way to identify causal relationships.”
From https://statisticsbyjim.com/glossary/validity/ :
“If repeated measurements are inconsistent, theyâre not a valid measure of the characteristic.”
And all of that does not address bias.
From https://en.wikipedia.org/wiki/Stochastic_process :
“Stochastic processes are widely used as mathematical models of systems and phenomena that appear to vary in a random manner.”
from https://stats.stackexchange.com/questions/273161/what-is-the-difference-between-deterministic-and-stochastic-model :
“A model or process is stochastic if it has randomness. For example, if given the same inputs (independent variables, weights/parameters, hyperparameters, etc.), the model might produce different outputs.” … “As a general rule of thumb, if a model has a random variable, it is stochastic.” Humans: heterogenous and unpredictable.
Random vs Deterministic. The model assumed to meassure a correlation is part of how to interpret the statistics of published research in ALL MH interventions. And they might be plain demonstrably wrong. Ironically without reading the numbers, just by the statistical models used.
Arguing about the effectiveness of an intervention when the statistical model to reach that conclusion is wrong might be an exercise in futility and an act of deception.
But there might be “heterogeneity of variance”, but from the aggregate, the some sometimes someone suggest randomness, not determinism. And still, heterogeneity of variance, is a characteristic of random variables.
from https://en.wikipedia.org/wiki/Homoscedasticity_and_heteroscedasticity :
“The existence of heteroscedasticity [heterogeneity of variance] is a major concern in regression analysis and the analysis of variance, as it invalidates statistical tests of significance that assume that the modelling errors all have the same variance.” Typical: just publish the average…
from https://mathvswild.com/stochastic-vs-deterministic-models/ :
“The fundamental distinction between these two types of models lies in the level of uncertainty they account for. A deterministic model will always produce the same output for a given set of inputs, while a stochastic model will produce varying outputs due to random fluctuations.”
“Additionally, due to their ASSUMPTIONS, deterministic models will always produce the same outcome for a given set of inputs, while stochastic models will produce different outcomes.” The upper case is mine.
Doing intervention research in MI might be deterministic, but the outcome for people is, as presented, stochastic, or random. Eeny meeny miny moe. And it’s analysis might be fatally flawed…
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Yes, it is good to point out what works for one person does not necessarily work for another person. Including medication.
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KateL, the questions you raised are exactly the ones you would hope someone licensed to “treat” people with “psychiatric disorders” would ask. The fact that they rarely are is what’s so alarming. And it happens because most “mental health clinicians” believe the garbage they’re taught.
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All great questions and points kateL! I also donât understand this article in many ways.
I also think people should NOT be allowed to charge money to diagnose, prescribe toxic drugs and therefore ruin peopleâs health and lives. All these actions cause significantly more distress and a lot of unnecessary added extra dysfunction. If they must âhelpâ, I especially donât think they should do this until they are completely stable and secure. But who the hell is? No one!
So I sayâEND the mental health system. It only furthers and makes ordinary peopleâs lives suck even more!!!
Trauma is REAL. Distress from it is REAL. We all deserve FREE help with that distress from people who know and care about us. Not from âprofessionalsââpeople who pay for letters to be added after their birth names.
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This article is challenging and nuanced, which is exactly what I like about MIA. If the whole site was just a one -note “all labels are bad, all licensed professionals are bad, all pills are bad for everyone all the time” echo chamber, I would have gotten the point and stopped reading years ago.
It seems like EA is making a subtle but very meaningful linguistic point when she says “borderline personality organization” rather than “borderline personality disorder”. It’s basically the distinction between “fever” and “influenza”. Saying someone has a fever is just describing an observable set of traits that could have any number of causes, while diagnosing them with influenza is making a specific claim about causation and underlying mechanism of action.
Much of the harm done with diagnostic labels starts with the oppressive and unscientific practice of treating them as infallible descriptions of the CAUSES of human suffering (influenza/borderline personality disorder), rather than ever-evolving descriptions of the various EFFECTS of trauma (fever/borderline personality organization).
EA makes it abundantly clear that her “borderline organization” is 100% caused by her childhood trauma.
Trauma can have various effects, the same way a car accident can cause a broken leg in one person and a concussion in another. Developing accurate and compassionate terminology to describe the various types of human trauma responses is necessary for imperfect people trying to help each other heal in an imperfect world. So, I applaud EA for doing the messy work of developing the necessary new language, and giving us all the chance to think about it more deeply.
I’ll also say, if anyone described themselves as “fully healthy/healed/recovered” or “completely stable and secure”, it would set off my narcissist alarm right away. The only therapists I trust are the ones who embrace the truth, that they’re traumatized, imperfect, constantly learning and changing people just like me. That kind of therapist can actually be a humble and valued companion on my own healing journey, rather than an authority figure to judge and “fix” me. So the more psychiatric survivors working in the mental health field, the better. There’s some good subversive work to be done, for those who can remember where they came from.
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CallMeCay, your points are well-taken. But all nuance aside, the grim reality is that dealing with the “mental health system” is a less than life-enhancing experience for more than a few people, and there’s usually no way of knowing what kind “therapist” you’ve actually got until the damage is done. And if this weren’t the case, there’d be no need for MIA. So my question is this: why isn’t just finding a “humble and valued companion” enough?
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I’m pretty sure this comment will be moderated, but I’ve been silenced and told that I don’t know what I’m talking about my whole life. I’m used to it.
The passage below — in which “borderline” is spoken of as a legitimate diagnosis, followed by a list of “bad” behaviors that are said (by experts and exes) to be “typical borderline” – provides ammunition to those who think it’s okay to abuse and ostracize people with this diagnosis.
“My âborderlineâ organization in those years frequently looked like this: if I woke up in the morning and felt a certain way, it was my belief that these feelings were reality, and that I then had every right to act on those feelings towards every person I encountered, no matter the consequence. I was volatile, self-absorbed, and narcissistic.”
We’ve all done things we’re not proud of. Most of us have experienced trauma. To equate any action with the idea that it was somehow caused by “being borderline ” – particularly on this website that purports to care about the way diagnosed people are treated – is to invite more harm on people who are unfortunate enough to be burdened with this label. We are not all blessed with countervailing forces that lessen the effects of the stigma and ostracization that come with being labeled a borderline. I lost my whole family, my home, my physical health. I have nothing. I was blamed for doing worse after ECT because, they said, ” You have borderline personality disorder.”
And then the real hell started.
So much for drop the disorder. It never ends.
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KateL,
I too was frustrated at the serious discrepancies in this narrative, so thank you for pointing these out, and also for pointing out how pussy-footed MIA can be at times.
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I agree. The author’s narrative is more than a bit confusing.
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EA, your experiences resonated with mine. I have had some very similar ones (BPD diagnosis, hospitalizations for âbipolarâ symptoms etc.) & also ended upâafter trying DBT, etc.âin clinical practice.
In my own work, Iâve kept aspects of DBT I found helpful, but share some of your criticisms about it. I think DBT stops the relational damage of BPD (no small benefit!) but doesnât heal the core attachment wounds people suffer from. This is why I incorporate analytic methods into my work as well.
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I think one of the healthiest, kindest things anyone can do for themselves is to stop identifying with psychiatric labels.
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Well, I guess it works for people who want to work and get paid in the system to buy into the labels. Too bad for the people whose lives get destroyed by the labels. I guess they don’t count!
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Not necessarily, I have been labeled with 14 different psychiatric labels, most of them wrong. The right ones did help direct me to better treatment.
Borderline was the most harmful thing that I was labeled because the stigma was so bad and it was incorrect for me.
Being diagnosed as having Autism has really helped me. I am looking at symptoms from the lens of autism instead of the lens of mental health.
The stigma of certain mental health diagnoses is much worse than the label itself.
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Trying to leave aside the association between the diagnosis and the pain that comes from reading the narrative, one thing comes to my mind by the use of recursion:
—– What happens when a provider uses his or her lived experience to validate a diagnosis or a label when confronting a minor that could be diseased or “merely” labeled just because of child abuse or neglect? How does the therapist impartially and objectively decides if his/her condition or label does not interfere or prejudices the disease or label of a minor in the consulting room? Outside the consulting room?
Because to me that situation would be at least a conflict of interest, and someone who accepts such stigmatizing diagnosis and owns it, might have difficulty, even impossibility to be objetive and avoid overdiagnosing, underdiagnosing or misdiagnosing a minor. Particularly if more apt explanations other than the label or condition, in some more objective view, is actualy a better fit for such minor. Like C-PTSD, or simple child abuse or neglect with proxyfication of the Munchausen type, etc.
To my mind, of course, what do I know about clinical psychology. And I am not trying to shame and blame, I am formulating my questions from first principles: as a conflict of interest, probably lack of objectivity, unacknowledged commitment to the labeling process for some who despise the label for very good reasons, to whom the strictly “label” is not appropiate, etc. It might be good for those who also want to own the condition or the label, but a priori, how could anyone tell for sure?
i apologize if it seems offensive, it is not my intention.
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This happens all the time. Children get diagnosed with borderline all the time. Even though the so-called experts say it doesn’t happen. It happens every day and these children get sent to troubleteen industry or equally bad situations. Based on this lie. The problem is that they’re being abused at home, abused in every way.
Really disappointed in MIA for publishing this. But not surprised.
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Thank you E.J. For sharing a bit of your life story. Your explanation of Borderline Personality Disorder seems to be more positive in the fact that there is hope and light at the end of the tunnel. It is my belief if a person seeks help on their own; that is a huge step and needs not be shit down by the DSN or Psychology field like it has been by some in the past. To me, looking at a situation and/or individual with interest and curiosity instead of labeling them sure helps more in the healing process but that is only my perspective as others may see it differently.
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BPD is in fact C-PTSD (in my opinion), especially in your case.
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In my view, C-PTSD as a psychiatric condition doesn’t exist. It is a mere fantasy of a bunch of
theoretically misguided pseudo-activist clinical psychological and medical staff.
People who have experienced ongoing violence, exploitation, catastrophe, neglect either have found enough support to deal with it and don’t have any serious mental health problems or they have serious mental health problems that manifests in the patterns that are described in the personality disorders.
The biggest mistake that both the clinicians and the interested public do is that they think it is certain specific patterns of harm that provoke a certain organisation of a mental health problem response.
The opposite is true: The personality comes first and we deal with our environment, the nurturing and the harmful, in the interpretative modes that our personalities offer us.
When you have a personality that focuses on right and wrong and the environment is unjust you will try become a moral example, if you experience amounts of harm to an extent that you cannot cope with you become harsh, critical, and controlling to yourself and others and may develop anorexia or become a controlling and abusive spouse (psychiatrically: OCD types of behaviour) (personality type 1 in the nine-type-personality theory by Oscar Ichazo)
The pattern that is psychiatrically described as a the type of emotionally unstable personality (borderline) is not so much concerned with right and wrong but it is oriented towards the relationship with parental figures and intimate personal connection. It is a very relationship oriented personality organisation and the drive is to have protective, nurturing, and intimate emotional bonds with others and have a sense for their identity as sensitive and special people acknowledged.
The inner organisation is that they try to create a certain set of emotions that they have chosen to represent their selves. However, because emotions are fleeting, they also lack a stable sense of self so that it is difficult for them to understand who they are. When they have experienced prolonged exposure to distress they begin to fill that sense of a lack in personality with fantasies about who they would like to be and the distance between their ideal and where they are in their lives begins to fill them with shame which can become the biggest obstacle at doing something to achieve their goals. They begin to be stuck in cycles of sub-manic or manic states followed by states of great suffering and pain (depression). They begin to envy everybody else on whom they project all the success and well-being that they found themselves lacking. (personality type 4 in the nine-type-personaltiy theory originally promoted by the Chilean psychiatrist and personality disorder specialist Oscar Ichazo in the 1950)
(People with this personality type are by far the most talented actors and performers because they are naturally oriented to harbouring and expressing certain emotions. I guess about half of the most famous actors have that personality type.)
The theory that you promote, that everybody who has experienced overt violence and neglect begins to be trapped in this specific emotional roller-coaster pattern (C-PTSD equals borderline hypothesis) has been researched for decades and could never be empirically substantiated. It is dead.
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Of course, I’m also against labeling, but in my country people labeled with C-PTSD diagnosis at least get help compared to people labeled with BPD who are just annoying to the psychiatric system and often no one even wants to take them into therapeutic care.
So I find the C-PTSD label much more beneficial during treatment of deep-seated trauma than getting a BPD diagnosis.
Whether it is true or not, the layman believes in mainstream psychiatry and the media, many psychiatrists can’t even explain what BPD is and how it occurs. Most society thinks that people with BPD are evil incarnate.
I choose C-PTSD over BPD (although it’s still not close to reality, but who cares in this society when we only divide everything into good and bad)
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When I was a counselor and sometimes had to do these “diagnoses,” I viewed them the same way, and told my clients as much. I said they’re just descriptions of behavior/emotion/thoughts that are used to bill insurance companies. I told them I’d select the one most likely to get them the kind of help they needed. I always favored PTSD or Adjustment Disorder because they would incline toward talking solutions rather than drugs.
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I did stop reading MIA for a long time for the exact reasons you said. It seemed anti all mental health care especially medication. Having been hospitalized 40+ times I definitely have some anger about the mental health system. However, it is not all bad like MIA used to suggest. Honestly, I was surprised to see these articles.
On a different subject, PTSD was never thought to occur in all people who are subjected to trauma. I assume CPTSD would be the same. One theory has to do with malfunctioning cortisol. Another with the support systems around the traumatized person. Etc. Etc.
I have never heard personality theory explaining trauma. That is interesting but problematic if you experienced trauma at a young age. How can you separate the trauma from the developing personality?
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My son was diagnosed with Bipolar disorder right after high school and has been to many therapists and psychiatrists and has tried many medications and has been self medicating with marijuana and delta 8. After reading this article I think there is a chance he may have borderline thought organization. EA I really appreciate the terminology of organization instead of disorder. I now feel my father and sister probably have the same emotional development so I feel it is hereditary. My father grew up in a volatile house, my sister grew up with our father being verbally abusive. But my son grew up in a stable household, was always loved and offered opportunity for expression. He was not abused. But in 5th grade he started with anxiety and then feelings of depression, then feelings of anger and blame towards me and my husband. He dropped out of college twice and now is trying to enroll in online program. He cannot hold a job and he has lost all his friends except for one.
My question EA is how can parents help, what do I do now?
I am writing this as I supervise him lying on the couch in a stupor from drinking and smoking pot after his friend had to cancel their plans for the weekend.
ALways living on eggshells…
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I understand you as a fellow parent. MIA’s parent support group was really nice and helpful for me. You might want to give it a try too.
https://www.madinamerica.com/mia-online-parents-support-group/
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I really appreciate that, thank you
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You are very welcome!
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The continuing problem of labels creates havoc and builds walls and barriers and I am unsure how to change this process.
Labels were used at times as a snapshot bevause many sense they were in crisis and needed a framework. More often than not the labels which have been used or old and never take into account intergenerational trauma of any sort and there are myriads of issues that come from human civilizations acts of commission and omission.
Mostly the driving force has been insurance the staffs Td term was adukt adjustment disorder but that sound Pat for only so many sessions to get more trestmrny to get paid other more serious so called labels were used. At a CUE course in the nineties the workshop leader said the DSM is a joke check out the labels of homosexuality disorder and the so called mental illness of slaves running away from slavery. It has never made total sense.
My best guess would be the more severe labels created a straight path to pharma.
There were several times in the past especially in some military eras where Traumss was acknowledged. As in WWI soldiers mainly elite who were treated for stress and then put back in the war.
Freud figured this out but was forced to recant because not only was his toting new ideas he was also Jewish.
This cycle was repeated over the next decades and somehow pharma won. If we all are to change the system or abolish then just stop using labels and create new or old words.
What about cyclonic crisis using the metaphor of a cyclone? The use of metaphors goes back into antiquity and only the person in crisis can understand as best one can under the stress of the moment what metaphor fits best.
A weather almanac of human cris across the range. And sn acceptance the range is wide and vast and not only TOT is needed an old medical term tincture of time but also TLC tender loving care ie process and compassion and work with that instead trying to rework labels. Labels do not describe metaphors do.
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Once, I made a comment to a professional, asking about their expertise in human suffering. They responded by mentioning their master’s degree, doctorate, and many years of experience. In turn, I replied, “So you are skilled in reading and writing, but that does not necessarily make one an expert in human relationships.” I am recounting this story to illustrate a point. We often forget that every single human is actually expert in human relationship â that is what it means to be a human! You may get it wrong or right but we are all expert.
The term “borderline” often relates to a stage of childhood development, akin to what we call the “terrible twos.” It signifies a phase of differentiation where some individuals don’t immediately relate to others; they differentiate first and then establish connections once they get to know you better so they may seem aloof or over familiar to fit into the society. We label these people as “borderline” because they don’t form immediate connections or overcompensate by over connecting without boundaries. This is oversimplifying but you get the gist of it. We are all unique, but diagnostic systems operate by creating rules, and deviating from these rules results in receiving a label. We all act sort of borderline when a relationship ends â the hurt, the fantasy, the fleeting bad wishes, the retaliation fantasy etc â imagine you are given that as personality! It is a nickname with damaging stigma in this culture!
In professional training circles, one must accept the diagnosis; otherwise, they may receive a more severe one and become ineligible to work in the field. The problem is accepting something due to culture does not necessarily mean internalizingâŚthis is not my idea. Any immigrant or expat does this. You see the culture and you take what is useful and leave what it is not. Borderline diagnosis persists because we are immersed in the culture!
Just adding: many diagnostic labels are only in the DSM which is not used internationally though its influence is another issue.
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Beautiful comments Dogworld! I’ve been wanting, for some time, to convey the developmental theory you have here (as BPD for having it origins within the ‘terrible two’s” fulcrum, but have deferred for several reasons). So big thanks there, because the ‘differentiation” factor is a most critical point, I believe! I would only add that the quality of ones fulcrum 1 stage (attachment!) is a vital factor in fulcrums 2’s trajectory, including parental presence and responsiveness during this stage. The tragic thing is, once these two stages are compromised, they are buried in somatic (unconscious patterns absent essential relationship), of which the “differentiation” issues are compounded in each ensuing developmental stage moving forward, including ones social life and its respective prospects.
IMHO ,our institutional psycho-psychiatric diagnostic systems (DSM, bio-medical, material, etc.) are an insult to the human psyche, and has devolved to the point of being little more than than a tool of social and political utility. In fact, I find it an insult to anyone who thinks fairly well or deeply, save morally.
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Kevin, you mention developmental theory, which is probably true in a lot of instances. However, you did not mention that emotional trauma (which can happen at any age) is probably what causes these two attachment stages to be compromised — and not mentioning the impact of emotional trauma as a probable cause of so-called “BPD” behaviors inappropriately places blame on the “client”.
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I am really angry that this article is even here. I find it very offensive. Quit with the labels. They are only there as tools for workers to get paid. They are numbers. But our whole society and government and families and individuals are being destroyed by them. They are just words with corresponding numbers!
You can have 100 people with a specific diagnosis from the DSM with 100,000,000 differences in all aspects of their livesâpast and present!!
Itâs all so awful.
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Invention of Chronic illness creates chronic customers. $$$$$ repeat customers. What motivates me more? Getting a steady income so I myself donât become as impoverished as my patients and no longer able to care for my own family? Or curing my patients until I donât have any customers anymore?
The problem with saving the world for a living is if your successful , youâre out of a job!
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There are plenty of patients. They don’t need to keep you sick to have work unless they are terrible counselors.
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Unfortunately, there are an unfortunately large number of terrible or mediocre counselors. I don’t think they “need to keep you sick” as much as not really understand what “better” means to the client and how to get there.
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E.A. – I am glad that you found a way to live with the challenges and the struggles that you experienced. I am never very convinced of people’s recovery though when they claim that it is their becoming a therapist that equals healing. I’d rather see people become healthy first and then start a career in a helper’s job.
Also I am happy if the concept of borderline personality pattern was useful to you in the process. I prefer the concept of emotionally unstable personality. “Borderline” is a very old term and refered to the belief that it was a psychiatric disorder at the borderline of “neurosis” and “psychosis”. A view that became obsolete because the concept of neurosis is not used anymore.
What I would like to make you and readers aware of is that there is a better theory on personality than the psychiatric personality pathologies. It is a theory that is called enneagram or 9-type-personality theory and it was first brought forward in the 1950 by the Chilean psychiatrist Oscar Ichazo.
Psychiatry’s borderline disorder corresponds to the personality type number 4 (sometimes called the romantic) when a person has experienced significant and chronic adverse life experiences and was left alone to deal with it or left without any useful support. The good news that the 9-type-theory offers is that there is a healthy organisation of the personality types that can be recovered when stress can be discharged and certain abilitites trained.
The personality patterns do not arise as an answer to specific patterns of violent or neglectful behaviours of our parents. It is just the other way round. The patterns are there very early on in our development and they offer us a way to respond and react to the environment (and offer us a protective and interpretative shield to violent experienecs like for example some parent’s abusive behaviours).
I am aware that this is going against the foundational belief of all kinds of psychodynamic psychotherapy theory that I call the car crash theory of the genesis of psychopatholgies because it (over)states that it is the harm that is done that defines personality.
You find a very instructive video by psychotherapist Beatrice Chestnut on the type 4 personality style on youtube. I am sure you will immediately be convinced by the accuracy of the theory by meeting your “personality siblings” there.
The best guide into all nine types is laid down in The Wisdom of the Enneagram by psychologists Don Richard Riso and Ross Hudson. A glimpse on the theory is provided on their website Enneagram Institute. The best qualitative self-test is provided by David Daniels MD, and Virginia Price Ph.D. in The Essential Enneagram. The questonnaires online are not reliable(!).
People well aqcuainted with the nomenclature of the psychiatric psychopathologies will be able to quickly and correctly link the psychopathologies to the correct types of the nine-type-theory and understand that they don’t represent a “break” or a “damage” in personality but that they are rather to be seen as natural personality foundational patterns that hav become overly fixed and self-defeating in the wake of prolonged exposure to adverse life experiences without adequate support.
I of course don’t want to criticise people who experience mental distress who want to understand themselves through the disorder nomenclature of psychiatry. I have done it myself for a while when nothing better was available to me. I just want to let you know that there is a more accurate and therefore much more helpful theory available to understand the personality patterns that nature provides, what happens to us when we experience too much harm without support, and how we can reclaim our lives and health and flourish.
Thanks for sharing your story!
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To believe that your personality- the core of your very being- who you are in essence- is âdisorderedâ or broken in some way is so devoid of hope. The very concept is devaluing to oneself.
Personalities are not stagnant- we are ever evolving. We are rivers, not lakes- moving through experiences day by day, changing beliefs and perspectives. You cannot step into the same river twice.
I would not go to a therapist who thought their personality was disordered, lest they think mine was also.
If one would like to say one had some trauma reactions that took time to tame and soothe, well that is something I think most people could identify with in some way.
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