The Potential of Borderlines

When I first read I Hate You Don't Leave Me, it said what I needed to hear--I needed to know what I was up against, needed to have the seriousness emphasized. When the golden "overachiever" who *thinks* she can just let "everything roll off her back" ended up in the Psych ward three times and was immersed in a thrice weekly therapy she used to think was rubbish--the author's blunt rhetoric and assessment was quite helpful to me. At least there was a *reason* why this was happening. I really *was* mentally ill--the book described many of my emotions and behaviors quite aptly. Dr. Kreisman pointed out a lot of stuff that was definitely present--a lot of feelings and motivations I had buried, hidden and denied, but deep down, always knew were there. Where his attitude differs from mine is how he assesses the possibility of real fundamental change. Perhaps having lived it myself, and seen it in others, I see the chances as being far more optimistic than he does. This is true of many therapists and those who write on the topic, not just Dr. Kreisman.

People say that borderlines are Incapable of empathy, incapable of mutually satisfying adult relationships--it implies to me that somehow, the pathologies and distortions of BPD are so deeply rooted, so inherent, that it is highly unlikely they will ever change. Maybe this is because so much of the book centers on crisis management. How to cope, as one who loves a borderline, or perhaps one who is a borderline, with these emotions and behaviors, almost tacitly accepting the fact that they will not change, that they cannot be changed. Only controlled. Turning the radio down, instead of outright changing the station.

Dr. Kreisman is a behaviorist, emphasizing short-term crisis-to-crisis coping strategies. His SET principles are good--actually a pretty wise way to interact with people, BPD or not, as well as a good strategy for parenting. My psychiatrist, Dr. P., undoubtedly used them too to get through the immediate tough times, outbursts in the hospital, irrational threats and impulsive self-destructive behavior. But Dr. Kreisman pretty much stops there, and doesn't seem to holdout much hope for a borderline being able to do much more than control the impact and behaviors of a pathological mindset. His strategies don't go the "extra mile". Fortunately for me, Dr. P. did.

Many therapists don't seem to think the "extra mile" is worth it. Alas, in the world of psychiatry today, there are far more who believe that borderlines cannot change their mindset in any really fundamental way, than those who believe they can. With the advent of psychological pharmaceuticals and short-term behavior therapies, psychoanalysts are becoming an increasingly rare breed.

A lot of this, I'm sure, has to do with the fact that insurance companies--who increasingly dictate treatments-- prefer the shorter and, subsequently, cheaper methods. Unfortunately, with BPD, the behavior is rooted in deeply held beliefs and viewpoints of life that just aren't going to be disassembled and re-built in a short-term behaviorally oriented therapy or an in-patient clinic.

In essence, some therapists advocate coping with BPD, as if it can't really be "cured." Like teaching a paraplegic how to use a motorized wheelchair, or a blind person to master Braille--resigning to these disabilities as if they are permanent, to be coped with, not cured. This it isn't true. Change is difficult, granted, but it is possible. Some therapists don't seem to believe that--not in any fundamental sense.

Thus, the "disabilities" of a borderline are considered a permanent condition the overwhelming majority of the time. Let's take a look at some of these disabilities. The purported inability to empathize. Manipulation. Self-centeredness. Raging vengefulness. Eerily similar to the marks of a lousy character, let's face it. The antithesis of the kind of people we are taught to aspire becoming. To dismiss the hope for these things changing--other than simply being controlled by a compassionate version of classical behavioral conditioning--is to say that borderlines are *always* possessive of such traits.

So I ask you--what, then, is the difference between a mentally ill borderline and a flat out lousy human being? If these traits are supposedly so inherent in a borderline that the chances of escaping them are dismally slim, does the origin of the traits *really* make that much of a difference, other than in a clinical sense? No wonder there's such a preponderance of therapists and others who think the best way to deal with a borderline is to avoid one at all costs, or to get the hell out--the hope of change absent, what's the use of sticking it out with a person destined to be a rotten human being for the rest of his or her life--regardless of the reasons why, the name it is given?

Long term therapy--the kind that bases itself on a philosophy that fundamental change *is* possible--is a vanishing art. Insurance companies don't cover it, it is the most time-intensive for a therapist who stands to make a lot more money in other ways. (Like a $75 fee for a five-minute hospital rounds visit or fifteen minute medication consultation versus $120 an hour of the frustrations of therapy.) The profits aren't there in the same way they are for short-term BPD or other mental illness clinics, that tinker at the edges but don't go to the meat of the issue. "Realizing that all people are different in both their motivations to change and the financial ability to seek fundamental change, it probably is true that, for many borderlines, the chances of any real change are remote. But is that a phenomenon of BPD itself, or of the medical costs culture in which we live? Kreisman appears to argue the former point, while I believe the latter. And, in the meantime, a lot of people give up hope before they've ever had a chance to try.

That in a very large nutshell (a Brazil nut, perhaps ) is what I mean when I speak of the attitude of many therapists--the belief that the traits of the borderline can best hope to be controlled and conditioned, not changed. Inherent and intractable. Once a borderline, always a borderline.

I don't buy that attitude, and I never ever will. I'm living proof. Fortunately for me, I have a husband and a therapist who never bought into the pessimism either. My entire life has changed and I'm alive to tell the story.

It's too bad that general pessimism is the norm and not the exception -- and those who have BPD and those who love someone who does are influenced by that view. In reference to stigma, if I *were* to disclose to people in my community that I had been diagnosed with BPD, the fact is that many, if not most, of them, would have no earthly clue of what I was talking about. It isn't a household term like depression or anorexia. But if they chose to look into it, chose to read up on it, perusing I Hate You--Don't Leave Me and other similar discussions of the illness--do you expect that they would believe that I've recovered? I tend to believe they would look at me with a newly vigilant eye, waiting for the fireworks to ensue. Once a borderline, always a borderline. A philosophy with which I adamantly disagree, but one, realistically, I have to understand is the primary one to which most people are exposed.