Thursday, August 5, 2010

Strengths and Resilience, Not Flaws and Damage

The label "borderline personality," like all personality disorder diagnoses, can be powerfully disheartening when you are on the receiving end.  It seems like an all-encompassing marker for a deeply flawed person.  I felt embarrassed by the term at first and was so relieved when a colleague of mine at another school suggested I research the "strengths and resilience" school of thought in Psychology (in place of the focus on assessing damage) and urged me to reframe borderline personality in terms of the gifts of empathy and other emotional strengths that come along with this personality organization.


In Jenne' Andrews' recent blog post on Loquaciously Yours - "Don't Call Me Borderline" - she writes about the destructive power of the term borderline personality disorder in her mother's life and in her own, and about the ways she and her mother both experienced a kind of eclipse of their creative strengths in the face of heavy pressure from the world of psychiatry to accept a view of themselves as terribly sick.
Please don’t get me wrong, I’m not saying I’ve never worked with people whose inner systems fit the criteria for the DSM categories of Borderline, Narcissism, and others. The difference is that I don’t use the categorical and shaming word “Personality Disorder” to describe a person’s experience and I don’t view people as fundamentally flawed. Deeply wounded, yes, powerfully protected, yes, but fundamentally and irreparably flawed, no.


I am especially drawn to the implication in her statement above that the "ugly" or "difficult" parts of borderline personality disorder are indicators of a very powerful and, I would add, often self-defeating system of defense mechanisms. I think of borderline personality disorder (or its less intense form, borderline personality organization) as a set of defense mechanisms gone haywire. Little bombs and tripwires and short fiery fuses set up in a circle around us and inside us. I definitely agree with the move to foreground trauma survival, trauma reenactment, and post-traumatic stress syndrome as the emotional musculoskeletal structure of borderline personality disorder. The idea of borderline personality as, also, a set of emotional strengths, resilience, and gifts is the very important other half of the new-and-improved story so many of us are now trying to tell about life with borderline personality organization.

17 comments:

  1. I must admit to really being tired of articles like the one you linked to that slam the term BPD without offering a real alternative. Isn't it obvious we need to call this SOMETHING? Otherwise, what do we google? How do we do research? How do we even talk about it?

    I'm also not a big fan of renaming it. There is no term proposed so far that includes the thoughts (splitting), feelings (fear of abandonment, etc.), and behaviors (anger, suicide, etc.) that typify BPD.

    The answer is to do what the GLBT community did with the word "queer" I'm out, I'm proud, I have BPD. Or don't tell, if you don't want to (no one with bipolar, schizophrenia, or eating disorders really wants to talk about their disorder either, unless it's private).

    I think the more treatable BPD becomes, the less stigma it has. The more we talk about the biological causes, the less stigma it has. The more education that is done, the less stigma it has.

    We need to increase awareness, and taking away the name doesn't do that.

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    1. How can you really be proud about acting in a way that destroys others? Being Queer destroys nothing by homophobic egos and bubbles. I've never ever met a BPD in my life that didn't attack or destroy other people on the regular.

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    2. How can you really be proud about acting in a way that destroys others? Being Queer destroys nothing by homophobic egos and bubbles. I've never ever met a BPD in my life that didn't attack or destroy other people on the regular.

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  2. I have never been a fan of the work of R Kreger. Particularly the binary categorization of bpd and non bpd. Moreover, Jenne's posts and this blog draw our attention to a more relational and processual account of bpd traits, borderline personality organization and/or bpd. Biosocially speaking, individual accounts and experiences are important to acknowledge so as to not reify bpd as some static condition. Granted, not everyone endures abuse but most of those who identify as having bpd traits would attest to growing up in an invalidating environment, which is much in line with Linehan's theory and practice regarding bpd. Some may not want to discuss trauma in relation to bpd traits as manifested in the individual--but it might be like talking about a burn without acknowledging the source of heat/said burn. I think we need to be careful--even researchers in the field for decades with MDs and/or PhDs adopt a modest stance in discussing the etiology of bpd. Focusing on bpd or bp organization as a condition/diagnosis with a hopeful prognosis is a huge move forward. The people living/who have lived with bpd like this blog's author, Keira VG, Amanda Wang and others are very careful in not making huge generalizations. It is important to work towards eradicating stigma and discrimination but it is also important to be critical of the social construction of mental illness particularly in relation to power and such factors as gender, race, class, sexual orientation/preference, gender identity, etc. I am finally going to suggest that I get nervous when well meaning but non-professionally trained (those that do not work with clients or conduct research regarding bpd) or folks who do not self-identify as having bpd traits write books, engage in public speaking, and/or contribute to knowledge production in ways that may not be helpful or sound. I am not the only one living with bpd traits who works with researchers (PhDs and MDs) who is critical of the work of Kreger. In fact, some researchers who are also practicing doctors or therapists recognized as "experts" ( a tricky term in and of itself) do not link to Kreger's work. I feel like Kreger tries to have such a public face in relation to bpd, although she is not so careful or thoughtful nor does she have special training and/or experiences in comparison to others. Sorry to sound bitchy, but this has irked me for some time. Thanks to all of the great work that has been circulating and for the careful thoughts about the life history and biological, environmental and socio-cultural factors influencing who does or does not receive a diagnosis of bpd. There is much debate over schizophrenia and let us not forget that homosexuality was in the past DSM manual. Kreger should exercise caution in speaking for others as she did in her previous post. Plus, she is not affiliated with any institution or center and lives in Wisconsin--that does not represent my reality and I worry about her sampling strategy--or from where she draws her insights and/or observations. Seems less helpful than not. Sorry if I offend anyone, but these are important issues.

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  3. Yes, I think borderline can become a kind of "queer" for those with what the World Health Organization terms "Emotionally Unstable Personality Disorder". But the activists prepared to call themselves queer wouldn't have had so much political leverage without the many, many more who were willing to identify as lesbians and gay men. And many who identified as queer used the more socially acceptable terms lesbian and gay to describe themselves to family and workmates.

    All social movements have both a radical and a more conservative flank - especially the successful ones. In order to overcome the discrimination against borderline PD I believe we need to see both borderline activists and a more mass movement. That mass movement needs a label they can identify with and don't feel embarrassed to share with friends or workmates.

    As someone with a diagnosed personality disorder that is as yet unidentified, I think the question is not so much should bpd be renamed but should the classification of personality disorder be changed. For me the answer is an unequivocal yes. To pretty much anything at all really but my vote would be to see PDs as either stress disorders or developmental disorders. And a speedy removal of us from Axis II of the DSM where we are in the same box as those who are born mentally retarded is also called for. The developmental disorders have already been moved to Axis I. Change that stigma against PDs and I can see a borderline "queercore" type movement really taking off.

    And I was real pleased to meet a potential nucleus of that movement thru this blog :-)

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  4. This comment has been removed by a blog administrator.

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  5. Anonymous, I am not offended at all by your post. In fact, I admire you for posting in a reasonable way. Here are my thoughts:
    1. All a non-BP is someone in a relationship with someone who has BPD or BPD traits. This includes relationships in which both people have BPD. It is not meant to be a division, but a writing shortcut. People seem to read more into that, but there’s not much I can do about it.
    2. There are a ton of people who write books and blogs and such who are not clinicians who have an advanced degree in psychology or social work. This includes all the people with BPD you mentioned who have books or blogs. I don’t pretend I am a clinician, but a “reporter.”
    3. I agree that Jenne's posts and this blog draw our attention to a more “relational and processual account of bpd traits, borderline personality organization and/or bpd.” I also agree that “biosocially speaking, individual accounts and experiences are important to acknowledge so as to not reify bpd as some static condition.” This includes both people with BPD AND their family.
    4. I also agree that “not everyone endures abuse but may grow up in an invalidating environment, which is much in line with Linehan's theory and practice regarding bpd.”
    5. I agree that “some may not want to discuss trauma in relation to bpd traits as manifested in the individual--but it might be like talking about a burn without acknowledging the source of heat/said burn. “ But I also think to talk about the impact of BPD on the family second hand, we need to talk to a family member (which I happen to be), having had a borderline mother)
    6. I agree that “we need to be careful--even researchers in the field for decades with MDs and/or PhDs adopt a modest stance in discussing the etiology of bpd. Focusing on bpd or bp organization as a condition/diagnosis with a hopeful prognosis is a huge move forward. The people living/who have lived with bpd like this blog's author, Kiera VG, Amanda Wang and others are very careful in not making huge generalizations. It is important to work towards eradicating stigma and discrimination.” ****I don’t make huge generalizations about anything.**** In fact, I am one of the few people who write about all the diversification in causes, treatment, what BPD looks like in various individuals, comorbid disorders, and so forth. If you don’t know this, I wonder if you have read my books or your knowledge is all second hand.
    7. You said “In fact, some researchers who are also practicing doctors or therapists recognized as "experts" ( a tricky term in and of itself) do not link to Kreger's work.” However, many do, including Robert Friedel, MD and Dr. John Gunderson himself. BPDCentral has some 250 links from websites, and almost every therapist I know recommends my work.
    8. You mentioned the fact that I live in Wisconsin in a manner that suggests that it harms my credibility. What’s what all about? This rather amuse me.
    9. You said you don’t know about my “sampling strategy--or from where she draws her insights and/or observations.” When I do research, I read studies, I interview top experts in causes and treatment, I interview people with BPD, and I go by my personal experiences.
    10. ****Nowhere in your post do you talk about the topic of my post: the fact that we need alternative names.””

    I do appreciate your views, which some people share. But lots of people also like my work, including many people with BPD.

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  6. I am honored that my post has been referenced here. I did suggest that we collectively advocate for something like "trauma survivor" largely because such a phrase does emphasize strengths. I see the value in de-stigmatizing and keeping the name but I wonder if it's really possible if the word "Borderline" is retained. That word does not connote splitting or fear of abandonment any more than another name would... For me the point continues to be to co-validate that each of us is far more than the label and the diagnosis-- as is made clear by the sheer brain power in the post and comments! All best-- Jenne'

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  7. A P.S.-- Randi-- your work is admirable. One emerging subject in the conversation for me has to do with how those in close relationships with the Survivor are so very focused on her/his behavior. I think it would be good to take a page from Alanon-- I dispute that the Survivor lives in Oz and her partner in Kansas/normal land-- Trauma survivors/the personality "disordered" neither act nor react in a vacuum. Invalidation is real, abandonment is often real and in our relationships there are at least two people in trouble. "Normal" is out the window.

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  8. Kreger, I see how you use bpd and non-bpd, but it seems much like the ways in which grouping folks into two categories can lead to unhelpful division that does not acknowledge the complexities: gay v. straight, male v. female, mentally ill v. not,--I guess when you read the diagnostic criteria, one can see how the traits might apply to many people over their life course. DBT focuses on developing skills to assist in better emotional regulation, thinking and behavior so I thought you were holding to bpd and non-bpd as categories to incorporate signs of emotional instability, feelings of depression and emptiness, identity and behavioural issues.

    I realize you are well cited, but I still get nervous w/ the title "walking on eggshells". Perhaps I am sensitive to my own flaws/diagnosis. However, it seems as though people without bpd also engage in unhelpful and unhealthy behavior towards others and bpd is so often attached to women in ways that seem damaging. I did not mean anything bad about Wisconsin, but I lived there and no one diagnosed me with bpd/bpd traits and several mds/therapists insisted it was bipolar--not to say NY, CA, FLA, Chicago, WA, are better but these are places where there is much research and treatment re: bpd. Therefore, I thought there would be more people--also bc such areas are more densely populated with patients, survivors/those recovered, and researchers, practitioners. I did not mean it as a swipe at WI, but it is true that larger urban areas do tend to more open-minded about many social, political and health related issues.

    Otherwise, I just think one should be careful. That is all I meant. I have benefited from people who are not doctors, practitioners or living with bpd in terms of better understanding bpd. However, after reading some of your work I do not want to be thought of/assumed to be that person that makes others around her "walk on eggshells" simply for meeting diagnostic criteria. I hope a tone of respect and gratitude comes across but folks with bpd are so often slammed in popular culture and there is such a spectrum of us. I deeply empathize with you as I believe my mother had bps traits but I was able to leave home early. I think we need to think of how people with certain mental health conditions have been criminalized and pathologized. Perhaps if we look at the criteria and considered the UK's term ‘Emotionally Unstable Personality Disorder,’ we might think of how we can improve the lives of anyone struggling with various aspects of the bpd criteria. Lastly, I am obviously very sensitive because I waited so long to see certain voices emerge that discuss living with bpd in honest, diverse and hopeful ways that are authentic to them. When it is only books such as your own that come to peoples' minds, the mythic bpd beast of a woman who drowns her children, yells and makes others "walk on eggshells was all we really had to imagine. It seems as though people working with many folks dealing with bpd traits often have helpful insights and express empathy and even respect for their clients. In any event, I guess I want to see a broader spectrum that represents a range of people living with bpd, but so would every group or population. I also go back to Jenne's point about trauma, abuse and an invalidating environment shaping one's relationship to bpd. I know we all define abuse, trauma or invalidation differently but I have yet to meet someone with bpd who has not had such an experience although s/he may or may not engage in self harm, yelling, suicidal acts/thoughts, etc.. However, I see how research into biological and pharmacological aspects is important, such as recent work on opioid deficits.

    Ok, enough from me. I do think you are down for the count Kreger and an ally, but some of your work still makes me a little nervous, which is definitely not a bad thing.

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  9. Thanks, everyone, for this dynamic thread of conversation!

    Anonymous - can you provide more info on the recent work on opioid deficits in borderlines? Sounds fascinating . . .

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  10. In response to Randi Kreger's comment: "The more we talk about the biological causes, the less stigma it has. The more education that is done, the less stigma it has."

    Many, including myself, along with many professionals as well, do not believe that BPD is totally biologically caused or that that has been at all proven. Secondly, to forward that as science is not to be on solid ground, despite the various "big names" that are touting this. The more the "biological cause" camp thinks it is diminishing stigma the more I just shake my head, frankly. The more this very unproven conclusion continues to be forwarded as actual science, the more people with BPD feel hopeless about recovery and wellness and the more the concept of personal responsibility is being over-looked.

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  11. One part of this conversation that stands out to me as worthy of further dialogue is the dynamic between borderline personalities and their partners or family members.

    Randi writes, "All a non-BP is someone in a relationship with someone who has BPD or BPD traits. This includes relationships in which both people have BPD. It is not meant to be a division, but a writing shortcut. People seem to read more into that, but there’s not much I can do about it."

    The shorthand of borderlines and nons creates a binary and, worse, a hierarchy not unlike black/white, female/male, gay/straight - so that the dominant cultural category (white, male, straight, etc.) is (mis)perceived as the universal or normal category, and is treated as a kind of blank space, a non-visible and non-involved person or subject position.

    I am a strong advocate of specificity, so I would like to see the language shift from "nons" to "partner," "family member," "caretaker," or, in a more diagnostic direction, "narcissist" (as Joan Lachkar writes, it is often the case that borderlines partner with narcissists).

    The other part of the conversation that has stayed on my mind for the past few days is the idea of borderline personality as multifaceted, a mixture of dysregulated states and self-defeating patterns, on one hand, and strengths, resilience, and gifts on the other. I think the strengths, resilience, and gifts part of this thread has gotten lost among the other points of interest and debate.

    I wonder if that topic is less stimulating, less important, less familiar, or less hotly contested that the topics of names and labels or nons and layperson knowledge.

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  12. I don't believe that your topic in this post, or any other, is less important than the other topics in the comments here at all. In fact, your thoughtful way of exploring these dynamics within borderline personality and the experience of what that means from the inside out, as opposed to how it is judged or evaluated by others, and psychiatry, is most refreshing. What many with BPD perceive to be negative and broken about themselves, flawed, damaged, etc, - vulnerability, sensitivity, are two things that come to mind, often perceived as weakness that are actually strengths. The intellectual brilliance of so many with BPD along with incredible creativty, I think, are evidence of the resilence that you speak of. I absolutely agree with you that so much of the "emotional musculoskeletal structure of borderline personality disorder" has its genesis and purpose in trauma re-enactment as a way to try to resolve the abandonment, the trauma, the woundedness that hasn't yet been resolved or that many with BPD have not yet integrated into authentic self. So much of BPD is about what is out of balance - that's what painful and negative. Yet despite that, paradoxically, there is co-existing strength and resilience that holds the hope and promise of wellness. Keep writing what you are writing about. It is wonderful and unique. Just as is your memoir. You have much to offer and a depth of thought and reflection that is important for others to experience and be able to see possibility in and from. My other comment really speaks to the reality of unproven science that many more with BPD need to know more about because as you refer to, to view borderline personality through the lens of so much of the biopsychiatry marketing of medication as the only solution is to cast BPD in this dark, hopeless "sick" light. Nothing could be further from the truth. Borderline personality when one is still experiencing it is not the absence of many dialectics. And there is so much hope for getting well, creating a life worth living, recovery, finding emotional peace, balance and wellness.

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  13. Still honored to be in this discussion with such amazing people, whose voices are familiar to me. As I thought about this conversation last week I posted about shame-- http://loquaciouslyyours.com/2010/08/17/out-of-the-closet-into-the-world/ as I considered how it feels to combat the negatives of our disorder/organization. The post before that addresses art, intellect, healing. Everyone's points well-taken here. I welcome visitors to my blog/posts as well. I continue to believe that we are not the sum total of our reactions and histories in a vacuum, that our dysfunctions arise, our skewed coping mechanisms and quickness to react arises from core wounds into which salt is poured. I am concerned especially with how to become less vulnerable to the re-opening of the wound-- without living in my car on a mountaintop protected from all interaction. xxxJenne'

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  14. i loved this last comment & jenne's blog. thanks! who knew one could learn so much from a blog and related comments. believe it or not, i have only posted less than a dozen contents in my entire life so i greatly appreciate the insights, challenges, and references.
    (the same) anon.

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  15. I don't understand and never will the rationale behind calling people that are different mentally ill or flawed. 1 out of every 3 people suffer from some sort of mental illness in their lifetime. I work as a case manager and am working on becoming a therapist and I have BPD. I have never been formally diagnosed but over the years I have researched and it felt like someone was writing my life, what is in my head, what I had lived, both good and bad. It is so hard to accept the reality of the damage I have caused because I truly believed I was protecting myself. But it is also equally difficult to grasp the fears and the pain I feel weekly. I have come to the realization that I have to accept this part of me even if it means coming to terms with reality and how distorted my perspective has been. I have done so much that I am not proud of based on the premise that I would be hurt otherwise. But this is what I was looking for, the chance to see myself as a person, whole and wonderful as is. I do not have to view myself as broken, flawed, sick. I am strong and intelligent and motivated and raised four daughters on my own due to some of my own doing but also due to my poor choices in men.I also put myself through school. That wasn't my illness that was all my strengths, every one of them at work. I love myself ...good and bad. Black and white and I am teaching myself to understand the grays. I finally found someone to accept me as I am. He and my children have been by my side on this self discovery and self healing. I will overcome because that is the BP strength.

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