Borderland

The diagnosis of bi-polar disorder or even a diagnosis of borderline personality ^disorder^ rather than personality structure does not resonate with me at all. At Ambedkar University, we are partial to a depth approach to psychic pain – meaning that we see the symptom as a clue/communication to “personal”, familial and cultural psychic pain and pathology. We attempt, in a broad, inclusive framework that builds on Freud’s understanding of the unconscious – to understand psychic structure and processes rather than the play of brain chemicals. Here comes in childhood experience/trauma/the emergence of the self and of the gendered self (Oedipal/Ganesha complex resolution – separate paper on this later)

This is a paper I wrote for class (thank you Ashis Roy!), please see how much applies to you. You might have thought of yourself as – very moody, very sensitive, highly sensitive, empathic, misunderstood, too much for the world, too much for yourself, experiencing the constant dull ache of being alive…. you might be borderline.

Borderlinity is a personality structure not a disorder – it cannot be treated with medication. If I’d seen my emotional pain earlier and sought psychotherapy – I would not have had to experience psychotic level existential angst.

Without further ado – here’s a window into the world of BORDERLINITY

Introduction 

I will go with Nancy McWilliam’s understanding of borderline as a measure of the extent of madness rather than the type. This is in distinction to its portrayal as a disorder in the DSM 5, beginning with the DSM 3 in 1980.

Being on the border of neurosis and psychosis, the borderline self appears to be largely functional, but experiences far greater emotional instability and misery than a neurotic level self.[1] At the same time, this person will show sufficient appreciation of “reality” to be beyond the pale of psychosis. After reading The Psychotic Core, my understanding is that the borderline self’s unstable organization around a psychic void[2] makes it more susceptible to this core surfacing in times of stress.

Here we have excerpts from the readings buttressing this point. McWilliams says that borderline is more serious than neurosis but not vulnerable to “lasting psychotic decompensations” (emphasis mine). Giovachhini cites Knight observing that borderline patients were neither neurotic nor psychotic, but “at times hovered around the edge of a psychosis. They could become psychotic, but they frequently reintegrated sufficiently to cope with reality and minimally function.”[3]

Before getting into the distinctions and similarities between the neurotic, borderline and psychotic selves, I would like to describe the borderline self, address the question of it being an organization/disorganization and discuss its etiology (causation).

The Borderline Self – An Organization around a Hole-in-the-Soul

I have watched Gia, Girl Interrupted and Blue Jasmine – all some time ago. I also read some testimonials by BPD survivors. They describe a terrifying hollow/empty space where their self ought to be. This I could relate to, as at one point, I felt I had a hole-in-my-soul, a similar sense of emptiness, though to a far lesser degree.

The portrayal of the acting-out BPD (Angelina Jolie in Girl Interrupted) has been contrasted with the quieter suffering of the acting-in BPD (Winona Ryder). Both are slave to emotions that are overwhelming in their intensity – as one survivor puts it – it’s almost as though they suffer emotional hemophilia.[4]

Giovachhini attributes this propensity to being overwhelmed to the lack of an integrated self and says this is what propels the borderline self to find unique ways of achieving psychic equilibrium.[5]

This brings us to the question of the borderline self as an organization or a disorganization. If we see the human psyche as “rooted in the same type of world the psychotic lives in”[6] and believe, as Eigen says of Freud, that “a basic madness thus informs human life”[7] then madness is innate to all of us.

This is much like the bohemian view of madness that Adam Phillips talks about – where madness is both the source of and the solution to the problem – “…in these accounts it is our nature to be mad, and it is our nature to protect ourselves from this madness…And the ways we have found to protect ourselves or cure ourselves… are themselves mad.”[8]

The difference is in how well our adaptations to madness work – from the standpoint of society and self both.[9] Giovachhini actually addresses this question in the context of sexual acting out. He says the affects borderline people generate can be adaptive and destructive both – adaptive because they hold the unstable self together and give the self a sense of tenuous control – and destructive because the resulting behaviour is “unacceptable and inappropriate to their outer reality”[10]

The borderline self thus unconsciously organizes itself around the hole-in-its-soul in ways that appear disorganized to others and to its observing ego, if it is given support to develop.

Describing and Relating to the Borderline Self

It seems the borderline self can be counted on to be unstable; that there is a perverse stability to its instability. When we started discussing this kind of personality organization, I was reminded of a friend of mine who studies at AUD. She is a beautiful person, and though probably not borderline; seems addicted to chaos and drama. It’s almost as though if there is no ongoing crisis, there is something wrong. Though I think there is a stage in life where this is true of most young, hormonal (dare I say) women, including me.

The borderline self has a similar inability to handle boredom and stillness – or the need to generate affects such as an all-pervasive depression/anxiety/anger to hold the self together and keep more devastating existential anxiety/ontological insecurity at bay. Another route to this is losing the self in addictive behaviours – drugs, sex, compulsive thinking (the client Ashis Roy described), constant planning. I personally quite liked adrenaline for this purpose. Jumping off ridiculous heights will make you feel pretty alive. On stupid days, I do a bit of dare-devilry on my bike.

The borderline self-with-no-self not only feels too much; she also has great trouble in inter-personal relationships. She wants desperately to fuse with someone, but cannot bear the pain of what she believes is an inevitable estrangement – and will thus strike preemptively to spare herself the pain. Again, this is a pattern I can relate to – though over time and post the end of a five year long relationship with a maternally enthralled son – I have prioritized developing a strong and independent sense of self. Brene Brown has a great TED talk on vulnerability that helped me to appreciate my openness to intimacy while ensuring a minimum amount of self-preservation.

What I cannot relate to is the inability of the borderline self to tolerate absence, or imagine that a person misses/cares even though he is absent. {since then, and through talk therapy – I have understood that I share with my puppy-baby the inability to tolerate absence/wait – our object constancy is messed up} There I am closer to the depressive position of “why does this person care about me” than “he is not around and therefore he does not exist/matter.” There was a time in my aforementioned relationship however where we had achieved fusion to the extent that separation did trigger anxiety, and during fights I could be like the “crazy” people who call relentlessly. In my case it came from a sense of outrage that X could put anything above the seemingly catastrophic conflict at hand.

Similarly, I cannot relate to the inability of a borderline person to be alone, nor their incapacity for guilt. I wonder if their masochism is sadistic and they try to get back at people who offer them the chance to (as opposed to making them) feel vulnerable/dependent by threatening to hurt themselves.

Etiology

McWilliam’s does not address the etiology of the borderline self in great depth. She offers the insight that there is a “bewildering range of views” on the question; contrasted with the consensus around the clinical ways in which this psychic organization manifests.[11] In contrast, Giovachhini takes us through Freud’s and Mahler’s understanding of the timetable of psychic development, critiques it and offers his own understanding of the core conflict in the borderline self.[12]

He says the borderline self suffers due to a defective psychic structure, lacking in adequate functional introjects.

At the pre-mentational, pre-psychological stage, the infant experiences only a diffuse sense of anxiety or contentment arising from the state of the body. The baby relies on the mother to soothe it and is under the illusion of omnipotence, that it must only feel a need to have it met. In time, the child starts to recognize the illusion for what it is, in what Giovacchini calls the transitional space between the world-as-self (or self-as-world) and recognition of self and other.

At this time, the child that has had her needs met will be able to see the mother as fulfilling a nurturing function, and further, internalize this function as a “nurturing matrix”. I understand from this that such a child will recognize the importance of nurturance and introject it in a manner that allows her to care for herself, i.e. to perform that function for herself.

In the borderline self, the nurturing matrix is not completely absent[13] but is patchy and unevenly developed. This is why such people are unable to soothe themselves, or form relationships that allow them to feel comforted. They suffer, as per him, from a pre-mentational agitation that cannot be understood as the psyche struggling with itself, but as a structural defect that neither allows self-soothing nor the internalization of helpful experiences from the rest-of-the-world. This might explain why such patients are bad at accepting help, but seem to want it all the same.

The graduation through the transitional space allows the establishment of object relations and the consolidation of ego boundaries. If something goes wrong during this process, in other words, the baby will be unable to develop an adequate sense of self – the most central trouble with the borderline self.

Comparing and Contrasting the Neurotic, Borderline and Psychotic Levels of Pathology

By definition, the borderline self is similar to and different from neurosis and psychosis both; lying as it does somewhere between the two. It resembles neurosis because the borderline self will demonstrate adequate reality testing and will rarely have delusions/hallucinations etc.

Yet, it shares with psychosis the need to fuse with an object – whether a person or a habit. The borderline self will demand fusion and cut and run in panic; expecting betrayal. Similarly, the psychotic person can be extremely clingy and demanding, like an infant; [14] and then abruptly isolate herself. In psychosis, the person will additionally conjure up his own objects to lose his self to – objects that no one apart from him can understand.

Both in the borderline and psychotic self there is a great amount of projection of rage, manifesting in paranoia. The borderline self will use projective identification to see its rage as coming not from inside, but from the person it is directed at. It will then almost cause the person to fulfill its expectation of being let down by haranguing him till he feels he must leave.

An interesting difference is in the existence of an observing ego, the nature of the therapeutic alliance and the attitude toward the therapist. A neurotic person will be able to quickly form a therapeutic alliance with the therapist, and recognize the troublesome parts of her self as such. Both the borderline and psychotic self will be unable to trust the therapist unless she validates their ways of perceiving the world, in other words, assures them that the trouble is coming from without, not from within. While the borderline person will hate the therapist, the psychotic person is likely to be grateful to her.

A tabular representation of McWilliam’s exposition in chapter three of Psychoanalytic Diagnosis is given below:

Neurotic Borderline Psychotic
Functioning High capacity to function, some level of emotional suffering Seem functional until they regress. Characterized by instability Overt state of psychosis is dysfunctional – hallucinations, delusions, ideas of reference and illogical thinkingThere are people whose internal structure is psychotic but will not surface unless they are very stressed
Defenses Mature, second-order defenses. Primitive defenses in times of unusual stress. Presence of mature defenses (and not absence of primitive ones) is what distinguishes neurotic. Repression is favoured Primitive – denial, projective identification, splitting – hard to distinguish from psychotic patients when regressed PrimitiveWithdrawal, denial, omnipotent control, primitive idealization and devaluation, primitive forms of projection and introjections, splitting and dissocation.Pre-verbal and pre-rational – protect the psychotic person against abject dread so overwhelming that the chaos of the defenses is preferable
Identity integration Integrated sense of identity. Consistent behaviour, experience of continuity of self over time.Can describe themselves in some complexity, not at a loss of words. Describe others as multifaceted beings also Experience of self – inconsistency and discontinuity. Like psychotic people – may be at a loss when asked to describe themselves. Have identity confusion but they know they existCannot deal with complexity, tend to minimize and simplify. Not “concrete” or tangential to the point of being bizarre but dismiss interest in complexity of self and others Full blown existential terror. Don’t know they existBasic issues – body concept, age, gender, sexual orientation. How do I know who I am/how do I know I exist?Don’t experience others as having continuity of self either.

Describe self and others vaguely, tangentially, concretely or in obviously distorting ways

Reality testing Intact. Psychopathology is ego alien or capable of being made so Intact.Can be tested by picking some feature of their self-presentation and asking if they know it might seem peculiar to others Not intact. Ego syntonic magical beliefs about the world – confused by assumptions of reality that everybody else lives bySimilar strategy will result in their being frightened and confused – because it would be further proof that they are not understood
Observing ego Show capacity for therapeutic split between observing and experiencing parts of the self early in the therapy.Don’t need validation of their neurotic ways of perceiving the world even if the trouble is ego syntonic Does not exist. See interventions as attacks/criticismDo not have the capacity to observe their own pathology, at least the aspects that impress an external observer.Will need validation that trouble is coming from outside, won’t feel safe with the therapist unless they are given this reassurance. Genuinely think their paranoias/compulsions/beliefs make sense. No observing ego.Will need validation that trouble is coming from outside, won’t feel safe with the therapist unless they are given this reassurance. Genuinely think their paranoias/compulsions/beliefs make sense.
Transferences Because there’s a sound observing ego – therapeutic alliance is established where patient and therapist are on the same side, working with problematic part of the patient. Counter transference benign – neither the wish to save nor to kill Strong, unambivalent, resistant to ordinary interpretation. Therapist perceived as all good or all bad – alternates over different sessionsCounter transference – strong and upsetting. Even if not negative, has a disturbing, consuming quality. Professionals find themselves alternating between one position and the other – mirroring the sides of the conflict in the client at different times (want help, don’t want help) Counter transference – subjective omnipotence, parental protectivness, deep soul-level empathy. Tend to make very grateful patients. Like babies under a year and a half – wonderful in attachment but terrifying in their needs – therapist should be prepared to be eaten alive

[1] McWilliams, 50.

[2] I am picking up on a comment Ashis Roy made on my response to the Adam Phillips question – that madness could be an organization around a breakdown, perhaps.

[3] Giovachhini, 30.

[4] Jerold Kriesman and Hal Straus, I Hate You — Don’t Leave Me!.

[5] Giovacchini, 34.

[6] Eigen, 6.

[7] Eigen, 6.

[8] Phillips, 85

[9] Or perhaps for self due to society. We cannot imagine a self without society, so this is a blind alley, but worth flagging.

[10] Giovacchini, 43.

[11] McWilliams, 52.

[12] Giovacchini.

[13] This would result in death due to emotional under-nourishment/starvation as in the case of the orphans and the animal-like-2-year-old.

[14] Eigen, 18.

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2 comments

  1. Who is this blog for?

    I have gone through all four articles and while all of them fluctuate between ‘Just another to Somewhat Brilliant’, they do not have same goal.

    If all you are looking for are some kudos and likes on FB, this work is good however to make considerable difference, you need to have focused approach.

    If ‘The Obsessional” made me (read: average reader without any formal education in psychology) see your point, ‘Borderland”s technical Jargon makes me feel, you too are going to try to read me through the lens of your education.

    Remember: Some problems require you to think out side the box, others require you to ignore the box.

    Good Luck!

    Like

    • yes i use my education. thats why im still in college

      mirrorwork’s’ knows what its doing.. and is taking time to set up. slow and steady

      stay with us if you like!

      bye. aqseer

      Like

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