Not so many years ago, Borderline Personality Disorder was considered untreatable. What is BPD? its name gives us a clue. At the time BPD was identified, it was regarded as a disorder in which the person was on the border between sanity and insanity. That idea has changed. It is now pretty much agreed that people with BPD are sane; they just drive other people crazy.
Particularly their children. James Masterson, with whom I studied, was the first to develop a treatment for BPD. Until that time, it was considered untreatable. But Dr. Masterson took a different approach, and it worked. It worked, at least, when he applied the treatment. The problem is, it is very difficult for a therapist to be resolute enough in applying the therapy while remaining completely neutral emotionally. When the therapist sees the Borderline doing self-destructive things, staying neutral isn't easy, particularly when a Borderline is damaging others, including their children.
Why does a Borderline mother damage her children? Masterson said Borderline moms don't always damage all their children. But, he said, a Borderline mother requires—he used that word specifically—at least one Borderline child. Why? She cannot tolerate feelings of abandonment. She must, no matter what it does to the child, cripple at least one child so that the child will never, even as an adult, be able to leave her. This means destroying at least one child's ability to function as an independent person. The child must never can outgrown a sense of being so part of the mother that—as Dr. Masterson put it—there is a belief by each of them that if one dies, the other will die. The potential for psychological blackmail is now visible, for if a child believes his very existence depends upon his mother's existence (or visa versa, and is thus responsible for her life), how can he venture far from her. "What if" she should have a heart attack and he is not there to save her?
That is precisely the problem a Borderline fear of flying client presented to me. She was in a Grammy Award winning singing group that was scheduled to tour Europe. When her mother got wind of this, she said to her daughter, "But what will I do if I have a heart attack and you are way over there?" That paralyzed my client. She and her Borderline mother were so enmeshed that to fly to Europe loomed in her mind as the equivalent of suicide.
How does this enmeshment develop? Let's say the child is 12 months old. At this point, if a toy the child is playing with is taken and put under a blanket, the child will not lift up the blanket and retrieve the toy. Why? Because when the toy goes out of sight, it stops existing, as far as the child is concerned. It is not just "out of sight, out of mind." It is "out of sight, out of existence." Apply this to the child's relationship with the mother; if the mother is out of the room, she—to the child—no longer exists.
But, in the next six months, that will change, for the child is in the process of constructing an internal replica of the mother, and when its construction is complete at around 18 months, the mother will exist—to the child—even if she is elsewhere. Fast forward to 18 months of age. The mother is playing with the child, but gets up and leaves the room. For a while the 18 month-old child is content. The child uses the internally constructed replica of the mother and of its relationship with the mother to keep the mother real to the child.
But, as the minutes go by, the internal replica's effect weakens. The child begins to lose an adequate sense of the mother, and needs to find her, and get a hug to physically renew his sense of her. Then he can return to playing alone once again. When the child's sense of the mother is strong, he acts as though he is very independent. This has been described as the child saying to the mother, "Mom, I really appreciate your taking care of me through these formative months, but now that I am fully grown and independent, I have no further need of you and I'll be on my way." And then, just minutes later, the child desperately needs a hug. The Borderline mother needs the child to remain clingy; she cannot take this "now I need you, now I don't."
Up until now, and up until the child exhibited independence, the mother-child relationship was perfect for the Borderline mother. But once the child shows any—notice that word, any—signs of independence (". . . I'll be on my way") the Borderline mother must nip that independence in the bud. When the child comes to her seeking her after rejecting her by showing signs of independence, the mother rejects the child. She treats the child as, "First you say you don't need me; now you say you do; to hell with you." Masterson called this "an eye for an eye" response the "talonic response." He said it is the most ingrained response by any Borderline, and when a Borderline is in treatment, it is the last of the pathology to go away. It is retaliation in kind; if you reject me, if will reject you. Even though what the child is doing is natural and healthy growth, the Borderline mother sees natural and healthy growth as rejection, and responds in kind. Thus, the child - who is at this point - dependent upon the mother with no choice but to give up natural and healthy growth. And, since part of natural and healthy growth involves what is called "separation and individuation" (separating ones identity from the mother and becoming and individual), development stops.
It is for this reason that Borderline Personality Disorder is considered arrested development, arrested at the age of 18 months, the time when the child's separation and individuation must be supported, not stymied.
From the child's point of view, up until he expressed himself, things were fine; mom was an angel. Now, upon his expression of himself, the angelic mother vanishes and is replaced byThe wicked witch of the West.
In order for a child to develop, he needs a single version of his mother to incorporate. But now there are two versions, the angelic mother and the wicked witch of the West mother. just when he was about to develop a dependable and substantial internal replica of the angelic mother, it turns out he can't depend on that version of her. This leaves him unable to construct a serviceable internal replica of her. And, since the mother will not respond to the child's genuine independent self, the child's real self does not get mirrored by the mother. This means the child also becomes borderline, unable—through being inexperienced—to construct any serviceable internal resources.
In other words, the child does not have an internal version of a consistent mother, nor does the child have an adequate internal concept of its own real self. And, since the mother rejects the child's genuine self-expression, when the child experiences emotion, the mother does not respond. A few weeks ago I wrote an essay about the motion world in which I said a parent would never go to Disney World and place a young child on the ride there alone. Instead, the parent would go with the child so as to comfort the child if the ride should become too much for the child to deal with. But the borderline mother, when it comes to the emotional world, lets the child experience emotions completely alone. Thus the child comes to regard emotions as causing feelings of isolation, abandonment, and perhaps terror.
Fast-forward to adulthood when the borderline once—child, now adult, attempts to be an individual and attempts to be a separate person getting on an airplane. The mother he was so dependent on is not there. Unable to function either as an individual or as a person who can regulate emotion, flying is difficult or impossible.
What we do to repair this in the SOAR program is to ask the person to find some single moment in their life when someone did respond, a moment when there was real connection. If we can link together the things that take place during flight with just one moment in which there was real connection with another person, anxiety about flying is sharply reduced. Step-by-step instructions for establishing these links are found in the book SOAR, The Breakthrough Treatment for Fear of Flying.
But anticipatory anxiety remains a challenge, for the very thought of doing something independently causes a replay of rejection by the mother—beginning at 18 months, but no doubt lasting throughout childhood, and extending into the present—and that powerfully remembered rejection and abandonment of his real self causes the person to experience, or go to the edge of experiencing, almost unbearable distress.
As this almost unbearable distress descends upon the person who is trying to operate as an individual, he is likely to abandon his attempt to operate as an individual, and if the feelings do not immediately subside, he may turn to the use of drugs, alcohol, sexually acting out, or even cutting himself to override awareness of the seemingly unbearable potential, the vivid recall of lifelong abandonment.
The session with the member of the singing group who believed flying to Europe was the equivalent of suicide took place years ago. But, I had a similar session last week with a client whose mother is borderline. The client was planning to fly the next day, but was feeling that she needed to cancel the flight. She said she was sure that if she got on the plane it would crash. She agreed however, that if she did not get the plane, it would arrive safely. I explained to her that—except in a Stephen King novel—the thoughts and fears of a person in the passenger cabin can not infiltrate the captain nor the mechanical devices on the plane, and cause a crash. My saying this caused her to recoil as if something had been said to her that she couldn't handle. She insisted that she was acting in her best interest by canceling her flight. I told her I couldn't take that seriously and I didn't believe that she could either. Then she said she felt confused. I remember Dr. Masterson's words: "Don't ever buy into a Borderline's claim that they are confused; they aren't they are in defense."
I told her that Masterson's triad was being played out even as we talked. Though she would first say she wanted to take the flight, she then said it was in her best interest not to. I pointed out that step one and step three were visible. Wanting to take the flight is the first step of the triad. Wanting to cancel the flight is the third step of the triad. I pointed out the missing step to her, the second step: the almost intolerable feelings that she developed when thinking of operating independent of her mother. These feelings, as soon as she started to have them, forced her to cover them over by quickly deciding it was in her best interest not to fly.
In some cases, then, anticipatory anxiety is a dynamic that involves what Dr. Masterson called the personality disorder triad. The person first tries to act as an independent person by planning to take a flight. Second, this independent behavior triggers the same feelings that took place when attempting to be a separate and independent person as a child. These feelings of abandonment are so intense that if they are allowed to reach consciousness, they will be almost intolerable. so the person quickly—perhaps automatically—covers over these awful feelings by giving up the plan to act independently. Further, the defense against these feelings is covered overby rationalization that ending independent action makes sense. By pointing out the triad, the defense against the feelings is revealed. The person becomes aware of the dysphoric feelings they are trying to get rid of. With the help of the therapist, these feelings are supported. When the person allows these feelings to be felt—instead of running from them—they no longer have to give up independent activity.