A somewhat working-through: Frightened Borderline

One afternoon a client walked out of my office (coincidentally, at the end of the hour) saying she never wanted to see me again. Her mood was undoubtedly complex, but I could tell she didn’t know it. This was her third session. First session – Assessment – I had made the tentative diagnosis of Borderline Personality. Second hour, tentative became confident and I talked with her about the nature and suspected causes of the disorder. I used Masterson, who sees the “world in a grain of sand” in flawed separation-individuation, the clinging and rejecting mother and detached father. As therapists know, there are nasty-ass Borderlines and there are those who lack the trademark bad attitude, are open to the diagnosis and to helping themselves. This client seemed the latter. Third session, the 23-year-old came in the room dragging lugubrious like an old peasant. Why? She would soon have a brain scan and MRI to figure out if she had fibromyalgia, arthritis or multiple sclerosis.

Very probably no. Her childhood had made her a soap opera character, driven to mothering her father’s sadness because mother was cold. She grew up in sexual identity ambiguity, submergence of her own self and needs, and all body: Moods became hair-trigger weight oscillations, fat thin, starve binge. Steeped in maudlinity and effective abandonment, she became “afraid of everything,” so far that any new stimulus in the environment was fear-making.

She was likely psychosomatic, all these exotic feelings and the burial of them making the body big, churning and toxic. Since I am not sophisticated in the subject, I showed her the popular Dr. Sarno 20/20 television episode on migratory pain (back, neck, ankle, shoulder in the video). Sarno’s theory is that a lot of the pain people suffer comes from “tension myositis syndrome,” mild oxygen deprivation in the nerves associated with personalities that harbor “fear, rage, stress.” She watched it silently, apparently taking it in. Then she attacked. “You think my pain is not real?” “No, the pain is entirely real, but it may have been launched by all the stresses and losses, cumulative and fused, in your growing up years. And I’m just introducing you to a theory.” I was not able to understand the nature of her offendedness as her upset peaked, she said good riddance, and left the room.

Let us say this is a third variation of Borderline: innocent, guardedly or suspiciously open to the diagnosis, but offendable in idiosyncratic ways. It might just be that she didn’t want to think she’d been hurt by her parents. But her peculiar mood seemed different from that. Did she want to have a serious disease? I’ve seen a fair number of women, early middle-age, obviously psychosomatic, who’d long bought into their body, not their child’s heart, being their suffering. But this young woman was new to her physical collapse, should want to cast it off, couldn’t yet be invested in it.

Or could she? I’d only seen her three times. I didn’t know what she thought of her erratic weight ups-and-downs. Just there, nothing to do with emotional stress, or the stress nothing to do with her parents? Did she think it was simply natural to nurture her weak father? Just what a daughter does? Some budding Borderline daughters who have Borderline mothers clingingly hate their poisonous parent, are malicious interlocutors with her at age twelve. They are regressed as they huddle in her lap, clawing at her stomach. But others, like my client, had a different, lonelier enmeshment – with a passive father, didn’t have blame to nurse. She had no one to lean on in love or anger. She became her own island.

I was pushing her to leave it, and be frightened.