Borderline Personality Disorder: A Recovery Perspective

To help my non-recovery-oriented colleagues understand the stigma/resentment associated with Borderline Personality Disorder, I simply mention this: “Let’s say I call you and say, ‘Hey, I’ve got a referral for you. She’s been diagnosed with Borderline Personality Disorder…’” I need go no further; without fail, my colleague will smile or laugh. We both know that such a referral is a no-no, so much so that it doesn’t even have to be mentioned – it is a given.

Irvin Yalom, at a recent APA division conference, was asked if he continues to work with clients. He responded with something to the effect of, “Well I am not taking any borderline clients.” The audience exploded with laughter. From the celebrity to the average clinician, it is known that “borderline” people are to be avoided. But wait, it’s not just professionals in the field.

A simple Google search for “Borderline Personality Disorder” gets more than 248,000 hits. There are countless best-sellers on Amazon dealing specifically with the “disorder.” Most of the books out there aren’t even for clinicians. Most of them are about how to live with (or otherwise be with) someone afflicted, or how to accept that you’re the one with the disease and how to get proper professional help.

There’s even a Borderline Personality Disorder for Dummies, which is either funny or sad – we can’t decide. Despite the spectacular array of books on the topic, it’s interesting that all of them adopt a consensus on what the disease is and where it comes from.

They know there’s no reason to continue thinking about it other than to figure out how to either overcome the disease or to live with someone who has it. People who had been diagnosed as “borderline” have come to see us for years. Our experience of working with these people, somehow, didn’t vibe with the body of literature on the topic.

First, why is there so much negativity towards people diagnosed as borderline? Is it because clinicians are heartless, vindictive people? Certainly, there are some of those, but there are some of those folks in every profession. Most of them, we suspect, did not get into the field to inflict cruelty upon their clients. What is it that they’re being taught that leaves them so guarded?

Second, we just don’t buy that psychology and psychiatry know all that many facts about the workings of the mind. Don’t get us wrong, we think they have discovered quite a bit that has been beneficial, even lifesaving, to countless people in (roughly) the last one hundred years.

But human experience is complicated, having many interacting facets and features, all of which interact in dynamic and ever-evolving ways. The field has learned a lot, but most of the information doesn’t represent anything like a mathematical fact. When people in the field take things as facts, we get a little concerned.

For brevity’s sake, we’ll stick with these two questions. To answer the first, let’s look at what is in the literature about Borderline Personality Disorder. It is considered an unremitting, debilitating biological disorder characterized by lack of empathy, being unable to adapt or grow personally, fostering vicious relational cycles, clueless as to their toxic impact upon others, severe impairment in sense of identity, impoverished sense of self, instability in regards to goals/aspirations/values, intense and conflicted close relationships, mistrustful, being emotionally unstable, generally negative, nervous, tense, anxious, depressed, antagonistic, fearing rejection, depressive, disinhibited (impulsive/risk-taking), having transient psychotic episodes, and one or many forms of self-destructive behavior, chronic suicidality – the list goes on.

By some estimates, the diagnosis is given to women 75% more than men. Theodore Millon, the world’s leading expert on personality disorders, describes four subtypes of BPD: discouraged, petulant, impulsive, and self-destructive. Upon reviewing the criteria, we don’t suspect that most people would want to meet this woman. She sounds like trouble.

Moreover, she sounds dangerous. Her chaotic behavior, affecting emotional storms, devouring attention, erratically putting her and others at risk reflects something more like a feral creature than a human person. No wonder people are afraid of them. This must be one of the most stigmatizing and dehumanizing diagnoses in the DSM. It made sense to me that such a damning diagnosis must have a significant history and, indeed, it does.

This leads us to the second question. Is this diagnosis as distinct and clear-cut as the DSM claims? Of course not. What is presented by psychology and psychiatry as a distinct diagnosis is a social construct, the product of many years of beliefs about the (perceived) feminine gone awry.

It is not just this but is also the result of developmental stress and/or trauma. Said differently, what is considered Borderline Personality Disorder is a person with developmental stress and/or trauma in his or her background set against the context of a cultural history of the ways our culture has thought about women.

Far from being biologically rooted, we have all the data we need to now say that the cause of what is labeled as psychiatric disturbance is a function of early stress and/or trauma. Moreover, we now know that many physical diseases are also rooted in the same causes. This is found most convincingly and recently in the Adverse Childhood Event (ACE) Study, which is consistent with a large body of research preceding it. And this applies to both men and women.

As an addendum to this idea that trauma can lead to all types of distress, we would like to make something important clear here. Trauma does not have to be a catastrophic event or a series of dramatic events happening over time. When we mention trauma, we mean any sort of experience that renders a person helpless, unsafe, or otherwise finding themselves in highly unpredictable circumstances.

Traumas are events that make apparent that – on some level, in our daily lives – we don’t have control over what happens to us. And when people have experiences that bring this truth about human experience to light, it can lead to major distress.

If so-called Borderline Personality Disorder symptoms are responses to an unpredictable and unsafe environment, then the real shame of it is that we are stigmatizing people that disclose the pain of our human world. We are judging people who have sensitive dispositions and absorb the world around them – people who are struggling with basic life issues.

Though the mental health system prides itself on exploring human behavior without judgment, this is a failure – not on our client’s part, but on the part of professionals and systems that are supposed to be caring for them. And this is the real shame.