(Shutterstock)
“She has no inner voice.” A stark sentence, a friend explaining someone’s emotional inconsistency. It stayed with me, stripped of its context, for days. Was it possible to not have an inner voice, a self that was busy connecting experiences and memories, stringing together a continuous personhood?
“When the voice that links the body to the soul vanishes, there is no way to put into words one’s feelings or will. I am reduced to pieces in no time at all,” Yoku Ogawa writes in The Memory Police.
Neither Ogawa nor my friend were talking about borderline personality disorder. But in Borderline: the Biography of a Personality Disorder, psychologist Alexander Kriss links the diagnosis to that same hollow, disconnected state. One patient, Ana, “seemed to be seeing something different every time she flipped back the pages of her memory: was she hero or villain, victim or aggressor? Her life story was like a jumble of scenes from a heavily redacted novel, roughly in order but stripped of the guiding language needed to follow the plot.”
Kriss offers a similar description of Rose, a patient who “had been robbed not of memory itself but of the connective tissue that gives memory meaning: the understanding of cause-and-effect, of why something happened in the way it did, how it made her feel, and how those circumstances and feelings informed what happened next.”
Confronted with one of these patients, Kriss’s colleagues duck like someone spotting an ex at a party. They are desperate to avoid “borderlines” they insist are impossible even to treat, let alone cure. Until I read this book, I took them at their word. My only experience with the disorder came from covering the trial of a young high school teacher and her fiancé, their lives irreparably damaged by someone with that diagnosis. Inexperienced, the teacher allowed this student to befriend her and even join the couple for a swim one evening. The girl later accused the couple, with convincing hysteria, of all manner of sexual improprieties. As a result, a promising young teacher had to leave her chosen field, while her fiancé, an immigrant, was forced to leave the country. Jurors never learned of the girl’s psychiatric history, her frequent accusations and retractions, her emotional instability. Infuriated, I recounted the case to a psychiatrist. He sighed heavily. “Borderlines.”
What, though, does that word even mean? When doctors first grouped characteristic behaviors, they were labeled “hysteria” in women and “hypochondria” in men. If someone veered into aggression or depravity, they were “morally insane.” None of those labels offered clarity, let alone help.
Then came a new label: “borderline personality,” popularized by Dr. Otto Kernberg in the 1960s. He noted that people with this profile could be hard to recognize—until they slid into emotional states disconnected from any sense of reality and wildly out of proportion. They wound up feeling martyred, persecuted, hollow, or unloved. Some escaped those feelings with drugs, cut themselves, threatened suicide, or went into explosive tirades and accusations that threatened the very relationships they were desperate to trust.
Kernberg saw BPD as a matter of temperament. He noted a continuum that ran from everyday neurosis all the way to psychosis. But Kriss sees BPD as the result of past, unacknowledged trauma. And he sees a far wider continuum, one with room for all of us.
Take “splitting,” a distortion of thought common in BPD. Little kids who feel abandoned or mistreated split all the time. They have to decide either that their parent was bad for leaving them, or that they were bad and deserved to be left. “Children, when forced to make this choice, invariably pick the latter,” Kriss writes. “They still depend on others for safety and sustenance, and so it is more adaptive to see the world as reliable and the self as corrupt.” (For me, this clicks a light bulb. It always made me achingly sad when children took the blame for their parents’ divorce or vices or neglect. It seemed so innocent, loving, and unfair that I never saw the logic behind that impulse.)
Adults split, too—that is easier to recognize as pragmatic. If someone ceases to be a person and is only a fascist, fanatic, or scumbag, mistreatment can be justified. “These splits arise at a cultural level,” Kriss writes, “in order to promote simple stories that maintain the status quo over complex ones that challenge it.”
Other signs of BPD slide all the way to normal on that continuum. Who has not fallen so passionately in love that their very skin felt permeable? Who has not turned irrationally furious if that love was unrequited? Who has not felt insecure, unloved, ignored, cut off from themselves, or desperately unhappy? Who has not, at least briefly, hated who they were and longed to be someone else, or lashed out to relieve the misery, or screamed something in a fugue state that barely connected to reality?
Kriss writes of another patient that his “madness, then, was not so much his holding of contemptible opinions but his inability to compartmentalize them, reflect on them, or bury them into the recesses of his mind like the rest of us.” Such a fine line, trembling between sanity and sickness. We darken it in a rush, nearly scratching through the paper in our haste to emphasize only the outrageous.
“BPD is a facet of the human condition pushed to its extreme,” Kriss writes, “but what’s too often depicted instead is an out-of-control, difficult person.” The sort nobody wants to treat or befriend.
In 1980, BPD moved into the coolly empirical realm of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). Rather than explore what the term “borderline” meant, the manual offered a checklist of possible symptoms. Though behaviors like cutting or suicide were hardly universal, they became hallmarks of the disorder.
Now the focus of treatment was to change behavior, making it calmer and less destructive. Eliminate the hysteria at any hint of abandonment, the craven need and insecurity, the rage at betrayal. All helpful changes, Kriss says, but if you urge them too vigorously on someone with BPD, you can “perpetuate the idea that they don’t belong anywhere.” If the disorder is “the result of history denied,” erasing its consequences only deepens the denial.
More recent approaches teach people to think through multiple possible causes for their distress instead of seizing upon an irrational conclusion. Kriss welcomes the acknowledgement “that much of the borderline experience involves a sense of being trapped in a terrifying reality.” Nearly always, he has found a history of trauma or abuse, and “what feels like an attack is often the other person’s attempt at self-protection.”
Is he just doing what so many liberal shrinks have done: erasing the diagnosis for the sake of freedom and, in doing so, erasing the chance of treatment? No, he has spent long, patient years treating people with BPD. He only wants a more nuanced, openhearted understanding of an often-shunned condition. The history of BPD, he says, is also “the history of medical authority—of who decides what it means to be ill.”
I like his willingness to call his profession to task. He remembers seeing, as a young psychologist, doctors standing outside a hospital chain-smoking while they bemoaned their patients’ unhealthy lifestyles. He remembers, too, how they often rushed to judgment. “These were not peculiarities of that hospital,” he later learned, “but a larger inverted reality that takes shape anytime one group is tasked with judging another group’s right to be free.”
Shallow, tainted diagnostic labels are noisy, like rock blared 24/7 to break a prisoner. This one brands you fragile, shrill, and outrageous—making it even harder to find an inner voice that could piece you together.
Read more by Jeannette Cooperman here.
