Borderline couple: Relax the facts

 

I learned a lot about Borderline Personality from the master – James F. Masterson, M.D., author of The Search for the Real Self and editor-author of Psychotherapy of the Disorders of the Self. Master­son discovered the origins of Borderline by contrasting the mental nature of his inpatient unit acting-out Borderline adoles­cents with the normal growth of the individ­u­ating Self as described by Margaret Mahler. Along with all the details of Borderline for­ma­tion and symptom­atology that Masterson imparted, I learned that it isn’t enough to perceive a palette of symp­toms and signs in the here-and-now client to make the diag­nosis. One has to learn about her birth, infancy, mother’s character, and early mother-child interactions extending into early adolescence. It doesn’t hurt to also see the father’s typical contribution of willful distancing (abandoning the child to the maternal symbiotic relationship with­out the counterbalance of external reality). So, you look at the “fragile extreme” character before you, and you see her troubled beginnings in withdrawing (WORU) and rewarding (RORU)* dynamics, the immature parents, the contemptuous adultified twelve-year-old daughter. Diag­nosing Borderline without that holistic background may prove accurate, but it will be lazy and more prone to error.

But sometimes you put those facts aside and see a woman who flip-flops with her boy­friend like a strobe light carried by horseback across quicksand. I can say to her that “Both of you are Borderline personalities bouncing off each other.” I can see and name the “idealization versus devaluation” and the “abandonment-engulfment” dynamics as consistent as the sun’s cycle, and nothing changes. Including a certain blindness:

She: “This stuff is overwhelming.”

Me: “I don’t know how obnoxious he has been and can be, but I’m pretty sure you have intrapsychic ‘guards’ up that protect you from feeling deep affection.”

S: “It’s not that he is being obnoxious or even difficult for that matter. I am just really understanding how badly I treated him and how hurt­ful I was to him. . . . I am unsure I can ever be better than I was but the other side of me feels like I owe it to him to be better because he really was a great guy.”

(Note: He has, by her earlier reports, been very obnoxious and demanding.)

M: “Looks like you’ve fallen back into the ‘he’s all good’ Border­line position.”

S: “No, I know he has faults and issues but I feel he is worth the effort because everyone will have something, don’t you think?”

(Note . . . .

S: “It is non-stop conflict. I know I may have expected a lot from the relationship but this is far worse than what I could have imagined occur­ring. It started about three weeks ago when things began to feel off and he began to act so childish. He would throw a tantrum when I didn’t pay atten­tion in a timely fashion or if I didn’t stop what I was doing to pay full attention to him. . . . . I couldn’t hear any­thing but his BS excuses of how I don’t give him enough attention, I don’t hold his hand when in bed, I don’t sit next to him on the couch, or so many other things that all seemed a bit crazy for a grown man to be acting so irate over.”)

Many clinicians, treating Borderlines, have waxed poetic about the intestinal constriction trig­gered, the toxic black tar of masochistic despair they inject into our heart, the sense of impotence they seem to purposely produce. And so it goes with her and me. The real answer, to return to child­hood, is theoretic­ally valid but impossible. A small girl, she had to be her own “attorney,” defend­ing herself before her sib­lings’ program of persecution and her parents’ neurotic acquiescence to it. This was not a childhood she could grieve. Calling for “Mommy” and “Daddy,” as one does in Primal Therapy, would only reach futility, the realization of loneliness.

Each return to her boyfriend – at least half-a-dozen times – the fighting has restarted immed­iately. She is a blocked forty-year-old, a needy and angry three-year-old. His neediness is a bit sick, his love too much for her. I don’t think there is anything to be done but hope that her messy kaleidoscopic turns to reveal some decision, and gets stuck there.

- - - - - - - - - - -

* Masterson's interesting terminology: Withdrawing and Rewarding Object Relations Part Units.