'Borderline' is Code for 'Difficult' is the title of an article by Bruce Bower in Science News. The article reports on a major challenge faced by women, and men as well, who suffer from borderline personality disorder and the relationship struggles that syndrome tends to bring. The article quotes Sandra Sulzer of the University of North Carolina at Chapel Hill who conducted extensive interviews with psychologists and psychiatrists. Her research clarified that the diagnosis of borderline, for all too many therapists, connotes needy, manipulative people, drama queens who do not need or benefit from treatment. "Clinicians," Sulzer said, "frequently view borderline personality disorder symptoms as signs of badness, not sickness..."
The attitude toward borderline personalilty disorder that equates borderline with difficult merits challenging. This blogpost is the first in a series of posts that aim to offer an alternative, more empathic, view.
The seeds of this post were planted by a reader who wrote an email to me complaining of what she had interpreted in my earlier blogposts on this syndrome as a perjoritive attitude toward folks with bpd. Often, emails and comments that I receive from bpd folks are overtly hostile and clearly misconstrue what I have written. By contrast, H.O.'s restrained way of expressing her concerns and apparently knowledgable perspective piqued my interest.
So I wrote back. And H.O. responded further.
The resulting informative dialogue about borderline personalilty disorder has influenced me greatly. I am pleased therefore to be able, having received H.O.'s permission, to share our dialogue with PsychologyToday.com readers.
Dear Dr. Heitler,
I am astounded and shocked by your articles in PsychologyToday.com which strongly judge and stigmatize people with BPD. They don't want to be treated like royalty. They just want to be loved, an emotion which many never experienced. Please do not contribute personally to yet more stigma which BP sufferers have to struggle with, in their already barely livable lives. There is stong biological vulnerability and often horrific abuse which results in this devastating condition. It is blatantly clear to anyone who interviewed BPD sufferers. Their dysphoria, or mental pain, which is their baseline mood is unbearable. Their lives are hellish. They do not need yet more patronizing and contemptuous articles like I am very sad to observe, your articles in PsychologyToday.
Thank you for sharing your concerns with me.
I apologize if I wrote in a way that came across to you as judging and stigmatizing. That certainly was not my intent.
Actually, I have become increasingly interested in finding new treatment methods for bpd, so I very much appreciate your feedback. Meanwhile your email has encouraged me to re-think my stance to be sure that I have sufficient sympathy for individuals with this difficult disorder.
Thank you again for taking the time to communicate to me your legitimate concerns.
Dear Dr Heitler,
As a physician who has worked with borderline personality disorder patients herself, and a BPD sufferer personally, I really appreciate your reply.
What I see as the most complex issue with BPD is that these patients provoke very intense "counter transference" reactions in their doctors and anger, or even hate in "normal" people. This emotional burden is not conducive to resolution of their problems and results in declaring borderline as impossible to deal with and frankly "bad."
We don't know how to live with others, how to have friends and get our needs met the normal way. We simply are ignorant in this respect.
If you read Freud's classic works he points out that intense feelings bring about "abaissement de niveau mentale" which means it clouds judgement to the point of insanity. Our uncontrollable and horrible emotions deprive us of ability to think and control our behaviour. Our behaviours are not meant to harm, at least not mine. Rather they are an expression of desperation.
We do not manipulate by cutting ourselves. We cut because pain of being borderline is so intense and so unbearable that the little kick of endogenous endorphins in reaction to acute physical pain is the only thing that brings relief from this horrific mental pain. How bad would you have to feel to want to kill yourself? We feel like it most of the time.
Please understand. Having a borderline personality disorder means suffering which I can only compare to terminal cancer.
If you saw a cancer patient howling with pain you would have compassion. The world does not have compassion toward us, even though we howl with pain, because our effort to escape unbearable pain cause behaviours which antagonize people.
Please believe me, if our pain went away we would not do any of the 'bad' things that the world finds inappropriate or harmful. We commit suicide because our pain is sometimes simply impossible to bear.
Please believe me, the depression and dysphoria of BPD is the most horrible feeling. Sometimes I prefer I had cancer instead. At least then the whole world would not blame me for desperate efforts to blunt the pain brought about by my biological vulnerability and abuse I suffered as a child.
BPD behaviours are nothing but inefficient ways to escape the pain. It is a vicious circle because these behaviours bring even more pain.
Pain distorts reality and results in what traditionally was called "borderline" psychosis. It is not true that we are not psychotic when symptomatic. Our perception of reality is so distorted by intense affect we do not think straight. Only after recovery do we realize how we were wrong and how our perceptions were distorted by the illness.
When symptomatic, a Borderline is in living hell, surrounded by perceived universal hostility.
I wish you all the best in your efforts to help alleviate this horrible condition and damage it brings both to the sufferers and those who have to deal with them.
Part II of this series on borderline personality disorder deals with patterns that might be labeled manipulative or sadistic.
FURTHER READING ON THIS TOPIC
Dr. Heitler's articles on this blog on the subject of borderline personality disorder include:
Denver clinical psychologist Susan Heitler, Ph.D, a graduate of Harvard and NYU, is author of Power of Two, a book,workbook, and website that teach the communication skills that save and sustain positive relationships. Click here for a free Power of Two relationship test.
Dr. Heitler's latest book, Prescriptions Without Pills: For Relief from Depression, Anger, Anxiety and More, is available now for preorder from Amazon or your local bookstore.