Kathy Ewing

Looking back at my life, I am rethinking previous, fraught relationships in light of what I have learned about borderline personality disorder. I recall a very difficult friend who was diagnosed with depression and was always getting mad at me. Hence, I was constantly apologizing. I remember thinking, “Of course, I might be at fault and need to apologize. On the other hand, how come my other friends never get mad at me?” Now, I recognize the BPD symptoms she displayed – turbulent emotions, feelings of victimization, black-and-white thinking, and so on.

Janus, the two-faced god

A particular student has also been coming to mind. He was diagnosed with depression and had suicidal thoughts. He had great difficulties learning Latin, and I tutored him outside of class and made accommodations on quizzes and homework to help him through the material. I found a former student to tutor him, too. Near the end of the year, the tutor confessed to me that this student loved and valued her but resented me, he told her, because I hated him and was trying as hard as I could to fail him.

I’m remembering how hurt and angry I was to hear this. I was devoting my free time to tutoring him, even though I never saw substantial progress. I often visited his counselor, partly to commiserate over him, but also to discuss stratagems for passing him in the course and to find out more about his history and diagnosis. I tried to be kind and warm in person, and I bent over backwards to assist him. Whenever we met, he  told me I was the only teacher trying to help him. I took that with a grain of salt, but I believed he was grateful.

All this, just to be accused, behind my back, of being out to get him! At the time, I didn’t think about this betrayal as symptomatic of his illness. I thought he was two-faced and hypocritical. Worse, I felt odd dealing with my other students for awhile. They mostly seemed friendly and appreciative, but how could I tell they were sincere? Maybe they all harbored suspicions they weren’t revealing.

Now, at last, I understand. My student had developed a crude coping skill of flattery, hoping to ingratiate himself with the person he was with. He wasn’t hypocritical so much as desperate. He was inclined to see the world through dark-colored glasses. He was inclined to feel victimized. Moreover, since I was someone who corrected him and often wrote bad grades on his papers, in his dichotomous world, I had, therefore, to be the bad guy.

His depression, in other words, was something else, or, at least, something more. I believe now that he suffered from BPD. The unpleasantness I experienced was not him, but his illness. So challenging are these symptoms to deal with, however, that I can still dredge up anger over the hurt he caused. I understand it better, but can still feel the sting.

We know that people with BPD often invest all their hopes and emotions in a single relationship; they latch on to someone, idealizing the new partner/savior and expecting unconditional love. They’re destined for disappointment, of course, because no partner is perfect.

Unwittingly, however, they have also selected a friend or lover with the same exact flaws as their childhood caregivers, if Harville Hendrix’s theory has validity. The relationship is fated to be rocky. The person with BPD may have even less predisposition to adjust, to perceive the patterns, to recognize their own part in the problems than the rest of us.

I wonder if it would help patients to point out the pattern. You, like all the rest of us (we could say), have deliberately but unconsciously fallen for someone indisposed to provide what you need. Complaining and accusing are the least effective means to change that person. Only by recognizing the patterns from childhood and not blaming yourself or the other person can you address the problems in the relationship.

My mother, for instance, maintained a cool distance with people outside the home. She was friendly and pleasant, but never invested anything of herself in these relationships. She put all her eggs in her husband’s basket, and then her kids’. We were supposed to make her happy, but we didn’t.

I can’t say whether my dad possessed her parents’ flaws, a al Hendrix. She maintained a high regard for my dad, despite his disappointing her by becoming a paraplegic. She spoke highly of him but not so highly to him. Instead, she was often critical and impatient. Then we daughters let her down in turn, merely by being ourselves.

None of these essential close relationships worked for her. She seemed unable to adapt. She couldn’t accept us as we were; each of us missed an invisible and unattainable mark.

Sometimes people ask me the meaning and origin of borderline. It describes a middle ground between neurosis and psychosis.

Those Freudian terms are a little out of vogue. To review, a neurosis is a mental disturbance of lesser seriousness. Fear of flying, for example, might be a neurosis. Or oversensitivity, or a need for control over your children’s lives. I always think of Woody Allen visiting his psychiatrist for years, lying on the couch complaining about his parents and his relationships. Chronic anxiety is neurotic.

The psychotic person, in contrast, loses touch with reality. Hallucinations and hearing voices come into play. Sociopaths like Hannibal Lecter are psychotic.

Psychoanalyst Adolph Stern coined the term borderline personality disorder in 1938 to describe a syndrome that seemed worse than a neurosis but not quite a psychosis. People with BPD can function in the workplace and seem normal much of the time. They rarely have psychotic breaks. On the other hand, their chaotic personal relationships and depression can destroy their lives. Sometimes they seem to distort reality, almost in a psychotic manner. If it’s a neurosis, it’s a debilitating one.

Dr. Joel Paris defines the disorder in this way:

Although we no longer believe that patients with BPD have an underlying psychosis, the name “borderline” has stuck. A much more descriptive label would be “emotionally unstable personality disorder.” The central feature of BPD is instability, affecting patients in many sectors of their lives.

Thus, borderline patients show a wide range of impulsive behaviors, particularly those that are self destructive. They are highly unstable emotionally, and develop wide mood swings in response to stressful events. Finally, BPD may be complicated by brief psychotic episodes.

Most often, borderline patients present to psychiatrists with repetitive suicidal attempts. We often see these patients in the emergency room, coming in with an overdose or a slashed wrist following a disappointment or a quarrel.

Interpersonal relationships in BPD are particularly unstable. Typically, borderline patients have serious problems with boundaries. They become quickly involved with people, and quickly disappointed with them. They make great demands on other people, and easily become frightened of being abandoned by them. Their emotional life is a kind of rollercoaster.

As Dr. Paris implies, the term is highly controversial and often considered a misnomer. The average person has no idea what borderline indicates. In addition, the disorder has accrued so many negative connotations that many believe the term should be abandoned just to start fresh, without the stigma.

Dr. Paris proposed a new name. Do you have any suggestions?