Borderline? I Don’t Think So…
Posted by Dr. Vollmer on January 15, 2015
Primitive mental state, that is what I want to call “Borderline Personality Disorder”. The name is pejorative, misogynistic, and used to describe a patient with a valence of hopelessness. Plus, as per the description above, many of the “characteristics” describe immaturity, and so most “Borderlines” tend to grow out of it. I would say that psychiatry has lost its way, as I often say, but in this case, this diagnosis has been around for many decades and I have always found it objectionable.
Laura, thirty, cannot find a relationship or a career. She lives at home with her parents, despite a graduate education in film. She is constantly breaking up with potential boyfriends, terribly depressed and hopeless, but then continues to find partners who disappoint her and the cycle continues. She has never looked for a job because she feels that a job is “too traditional.” When asked how she imagines being independent, she says “I will figure it out”. Laura is constantly angry. She is angry with her parents for not being “tougher” on her. She is angry with her sister for “not being there for her”. She is angry with her friends for “not including her in all of their plans.”
Is Laura “Borderline?” I would not say that. I would say that Laura is immature. She has failed to grow up and develop independence from her parents and her own power over her world. She has failed, so far, in obtaining a partnership which she experiences as fulfilling. To the extent that she is aware of her failings, she is angry and she turns that anger outwards towards those closest to her. Psychotherapy can help her focus on her need to make her mark in the world; her need to find work and love, as Freud would say. With these forward movements, her anger will subside and she will be “cured” of her personality disorder, which is to say that her developmental arrest would have been addressed, allowing her to grow, develop and thrive in her world. To label Laura a “Borderline” is to cast a long shadow over her future. To say she is exhibiting a “Primitive Mental State” is to describe the current situation, without forecasting her future.
In essence, my forefathers (since they were mostly men in those days) set us up to describe mental states as if we can see the future, when in fact, we are looking at a stunted development which can be set straight. To see the “Primitive Mental State” in developmental terms allows for great hope in the ability to access the genetically determined push towards independence and self-empowerment. To say that the patient is “borderline” is to say that their behavior is so unsavory, few people want to get close. The label matters. My rant continues.