Shirah Vollmer MD

The Musings of Dr. Vollmer

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.

3 Responses to “Borderline? I Don’t Think So…”

  1. Shelly said

    In your diagram, you show BPD interacting with bipolar disorder II. How are they similar? Is it only the depressive parts, the hopelessness? How can someone outgrow their immaturity if they are physically 30, 40 or 50?

    • Yes, our diagnostic system is flawed and there is overlap between BPD and Bipolar II. They are similar in their change of affect. Outgrowing immaturity is a mental process, and it is independent of age. Thanks.

  2. Dr. Vollmer, thanks for this excellent article. It is refreshing to see a therapist who is not lost in the Alice-in-Wonderland world of pseudo-diagnoses… it is tragic that our human need to impose order and patterns, into situations of complexity where there may not be any, has resulted in the creation of these non-scientific, meaningless labels like BPD that do nothing to explain a person’s history or explain why they are behaving the way they are. In my view BPD cannot possibly exist as a distinct medical diagnosis; at most it could represent a continuum, metaphorical term to describe a range of pre-oedipal developmental problems in individuals. Too bad that many people believe it is an illness they will have for life. If I had my way, the term BPD would be eliminated once and for all.

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