Nincompoops, Borderline, Part 2

I once explained to a 43-year-old client that he is still a little boy, has never ascended to the adult plateau. One might think this would be insulting to him. But my explanation was so discreet and strategically euphemistic, hovering, like an angel, above bullshit by a hair's breadth, that he accepted it with equanimity. (Mildly confused equanimity.) My client was the embodiment of what I would call Radical Borderline Personality: the rudiment of all personality disorder, the person whose Inner Child has remained so prepotent over time that the adult costume is powerless to contain it, to teach it adult falsehoods.

He panicked to go to work and be around the other workers. So he took several months' leave, abandoning his wife to carry two jobs plus management of the household. This barely fazed him. Much more important – he told her – were his needs for understanding, support, hugs and love.

When the therapist meets someone this pure, he discovers that the person genuinely can't understand his error, can't grasp the validity of maturity until the therapist attacks with assiduous directness, depth psychology, and inescapable logic. That is what I did, though as said, this was clothed in gracious language.

I don't know how many clients remain too much the child. It's possible that all of them do, even the high-altitude sophisticates. I mean this. Therapy speaks, then, to a fundamental sabotage: The adult's defensive persona must be strong enough to return to childhood pain and failure without drowning in it, without becoming it. But that means that the false self must ultimately predominate.

And yet there is this diametrical contradiction to futility: It is necessary to express our losses, to grieve. It is good to cry. It is helpful to rage, as long as the rage crashes through to its founding grief. It is human nature to need to give our pain to someone and to be held.

So which is it? Is psychological healing deceptive and illusory or real? Is therapy curative, palliative, or a fantasy? Can we, should we, approach the speed of light, but never reach it?

The nincompoops want to eliminate Borderline?

It seems that the existence of the Borderline Personality is being questioned.* Let me clear it up for all the PhDs out there. Borderline is dissimilar to the other personality disorders where there is a primary identifying quality and its ego-syntonic attitude. A Narcissist has perfection. A Dependent won't make decisions, requires the symbiotic feeling. Antisocial personalities have no conscience. A Histrionic person is shallow and dramatic and must be the center of a crowd. A Schizoid is detached. Each of these disorders can be revealed to have an attitude that is in harmony with the identifying feature. A Dependent is fine to be that way and may not even understand independence, may feel torturously uncomfortable with thoughts of separation, initiative and autonomy. A Narcissist finds the notion that he may be imperfect ridiculous, angering, unthinkable. A Schizoid is overwhelmingly complacent in his detachment. All these personalities have an endorsed tangible dysfunction.

Borderlines are thought to embody the stigmas of bitchiness, manipulation, of being emotional projectile bleeders. But many are not this way. They may not have a conspicuous brand. They may be assiduous (my first wife, Borderline, was a high school science teacher for many years) or infantile (unable to keep any job for more than a few days or weeks). They may brandish their primitiveness like a sword or badge of honor, or they may be sophisticated and cerebral. They may be suicidal and self-injurious or safe. They may be desperate for a relationship, or not. What makes these divergent presentations all Borderline? What is their underlying unity? A separation-individuation-stage developmental immaturity and its resultant out-of-sync-ness with the world of its time. It's the abort of psychological growth beyond infancy. This is a lost child in an adolescent's or adult's body. To be an adolescent or adult having to manage the world from an infant's inchoateness, confusion, emotionality is to be sane while insane, disintegrative but perforce held-together, a helium balloon of "thought" pulled under by an ocean of sharks.

Borderline Personality is not in the same trait category as the other personality disorders because it is the fundamental flaw at the base of all of them. The other personalities start from Borderline's failure to pass the starting gate in infancy. They all will reveal, in therapy, an essential immaturity, a "man-baby," a radical dependency on someone. The psychopath is completely dependent on victims, the narcissist on human ego supplies, the histrionic on an audience. "The creative work of these apparently detached individuals" – Schizoids – "may perhaps provide a round-about way of finding some form of social attachment."** Borderline is the skeletal structure of wrongness – the first mother-child breach – that will in time require global defenses, the pervasive, inflexible take on self and world, to maintain continuity in its second-by-second, day-to-day existence. As the other disorders will show this primordial "failure to launch," so Borderline will contain features of narcissism, alienation, dependency, sociopathy, eccentricity.

Sometimes I have diagnosed Borderline but have not recorded it in the client's chart. She might not meet official criteria, but there will be a fundamental incongruity, the prepotent impotent child competing with the adult, an immaturity that she is blind to. She will be smaller than her children, alienated from and rageful at them. She will speak and be triggered by her own words to tears because she is primarily pain. The therapist will have a feeling that says: She is not really here. She is in the past.

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* https://www.psychologytoday.com/us/blog/fulfillment-any-age/202207/is-it-finally-time-eliminate-the-borderline-diagnosis

** https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5840255/

A question to Republicans: Why so damned anal?

"In promoting depth therapy to clients, I explain how our ideas, beliefs, convictions may be guided by analytical thinking, but that analytical thinking is bent by the gravity of feelings planted deep in their history. I have them imagine two men age 50, both the epitome of physical health, both from the East Coast, both 200 IQ polymaths with doctorates in arts and sciences, having lived among the rich and the poor, oppressed and elite, both worldly in travel, reading, experience. One is a Democrat and the other a Republican. Is it rigorous thinking that has made them different? No: They are both eminently capable. It's the psyche, the way that early, formative emotional pain has been caused and treated by their caregivers that determines what ideology eventually forms in their brains. Pain is expressed and mitigated, or it is internalized to become the lens through which the person sees self, others, the world. These Republicans are the cornered rat; they are the lion with a thorn in its paw that no one ever caringly pulled out. Their passions are failure-based. One would sooner heal them by the arcanum of Freud or 'primal scream' therapy than see them change on their own." (Comment to a NYTimes op-ed – https://nyti.ms/3BdmzKY#permid=119465067)

This was a "for popular consumption" comment, lacking in some essential detail. * For childhood pain and injury to be "mitigated," it must be expressed holistically (words, feelings and gestures in sync) and held by someone else at the same time. This is historical pain that still lives in the child who still lives in the adult, and children need a savior, a believer, a parent. * When pain is "internalized," it becomes a lens not immediately but through time, the time of caregivers' neglect when scar tissue grows over it to protect the child. The scar tissue is the double-sided lens that warps feeling and perception.

David Calof, in his published interview, "Multiple Personality and Dissociation," noted that the so-called "inner child" is not the cute tyke described by John Bradshaw and other writers of the time. It may be full of rage. A worthy question is: What makes one lion with an impaled paw rageful, destructive and delusional, a different one hurt, wise and amenable to help? Why have so many Republicans, forcibly adult owing to their age, opted for anger after their childhood injury? Why do they clench their body, their throat, their fists as a form of self-protective power rather than exhale, release the tension, collapse in the truth of their hurt? Almost anyone (barring birth psychopathology) would be capable of this. I know it's not necessary to become hardened. In my late teens, I was that angry Libertarian with contempt for many, fear of the rest, alienated, ego-syntonically insular (the "self-made man"). I could find my buried, burning self. I could cry. I could read good psychology. Why can't they?

Why, even with the gift of therapy, even with a loving spouse, can they not finally lean on someone, relent to the deeper person within them?

The terse and the pithy: Cheating and careers

How is cheating on one's spouse similar to career dissatisfaction? While either affliction may have a number of causes, there is often a single phenomenon underlying both. It's the principle that explains, for many people, the problems of love and meaning.

We may love our husband or wife and still feel some inexplicable (-seeming) discontent. The men will look at every attractive woman who walks by, hoping their wives won't notice and think ill of them. One could say they are innocent because they don't mean to be this way: It is an urge the denial of which would feel like lifelong incarceration, like soul death. Similarly, we may be proud of our work – lawyer, architect, salesman, whatever – while feeling "this is not me. This feels like an act, a giving-up, a missing of something that is the real me."

Love is a feeling and meaning in life is a feeling. But our feelings are rooted in our childhood, where the chemistry of starved needs may infect them in their root structure. If early on we are starved of nutrients, we will grow up compromised: Our brain, our vitality will never be what they should have been. It is no different to be raised with conditional love or no love. We will always be needing something. We will always lack those chemicals of mother-love, unconditional love. And we will not know who we are, what our "meaning" is, because pain has blocked our natural self from participating in the world.

It's simple. We have been stunted in our formation. We remain the "inner child." The fact that this is unpleasant and "deterministic" doesn't make it less true. So much of psychology and psychotherapy is based on the wish (or delusion) that our mind, the master, floats free, above our history. It is the immovable mover and the god of ourselves. This is the magical thinking of the child within us.

The end of therapy

Books and articles on psychotherapy make a big deal of termination of therapy. The clinician should make a big deal of it. Clients need time to wrap their mind around ending this deep relationship, need time to review their gains, need time to gradually be set free to handle their life without the safety net of this drastic and intimate bond. Client and therapist talk about this process as it is happening over weeks and months, gradually weaning away to a poignant farewell.

Not in my world. I can say with certainty that most of my clients change in thought, insight and feeling, and therefore movement, as a result of our work. The great majority of them express appreciation. But there are very few terminations. Most of them fade away, stop coming in, no notice given, even those whose therapy casualized to friend and confidante over the course of a year or two. Just disappear. There is no reason for me to suspect that I am wrong about their benefits gained or their appreciation. But I know my work doesn't lead to happy positivity: more like sober or grave or blunt positivity. Clients may come to see they need to be hopeless about having loving parents. They may come to see that meaning in life happens in childhood – it is a healthy child's natural stimulation in the world – and that they will have to settle for different kinds of meaning. Evaporating their anger at their wives may come from finding and grieving their child-self and deploring or abhorring their father who shamed them. They may teeter on the edge – scissors trembling in their hand – of cutting the umbilical cord to a solipsistic miserable parent. That would leave them feeling, partly, homeless and selfless: a difficult state to consider "success" in therapy.

I can imagine that at a certain point, clients feel alone and go off on their own. That would be a paradox, as I'd tend to feel closer to them as time went on. They didn't have the positive-feeling bond with me because I helped them be their solo selves in a darker psychological world, not hoist themselves onto a platform of false feel-good, holding my hand, my glad-handed encouragements. That would leave them precarious, especially with a Cognitive therapy that produced a speciously warm relationship of thinker to thinker, not goad to feeling.

I'm sure, though, that some of them will be discomfited, those who want to live in their head while I've pointed them to the body, to the muck of their history. They will fade out, too.

If you own more than one gun, something is seriously wrong with you

 

A coworker of mine, around 1997, was a Probate Pre-screener, the clunky job title for social workers who respond to leads that someone in the community is acting mentally aberrant. The worker was a retired cop but very attuned to, compassionate and bland with disturbed people. One afternoon, I rode along with him to see a shut-in old woman with a long psychiatric history. She sometimes wouldn't eat, believing her food was poisoned. She'd venture out on a hot summer day wearing a winter coat, scarf, fur hat and gloves. John, as easygoing as Mr. Rogers in a hammock, asked her: "Millie, do you think you're the Queen of England?" No, she said. "Have a good day." We left. He knew she wasn't delusional enough to cause herself harm.

John was a solid, wise and grounded man. But he owned a big collection of knives, many of them old-fashioned switchblades. There was something very wrong with him.

Knives and guns meant to harm and kill. What does it say about you if you feel a need to own more than one for protection? What does it say about you if amassing several or many of them gives you a "good" feeling? You harbor a fantasy of murder or revenge. You feel terribly unsafe and may be paranoid. If you are warm to, and not frightened by, a hand-gripped device that can so easily kill accidentally, whose perfectly machined metal says nothing but destruction, you may be on the continuum of sociopathy. You may feel so weak, skinned, so shell-less an egg that you must armor yourself like the Bionic Man, the Tin Man. A suicidal person with a gun set next to him on the table feels more suicidal, more helplessly resolved, more pulled by the gravity of death. When he calls the Hotline, we ask him to carefully deposit the weapon in the most remote place in his residence then return and talk with us. Proximity to a gun is like proximity to sarin gas, or to a black hole, or to fate.

Human psychology is an infinite amalgam of sensations leaving stains in our chemistry, bleeding wounds poorly scarred over, molecules of happiness, pain and developmental abort, all of which come to inform our behavior and what we call our thinking. This vast ocean of time in a body means we'll never know completely who we are, and most people will not care to know. But we could learn a lot by diving deep into the feeling of wanting instruments of killing, of violence. Since the feeling is the fact – the thought is the rationalization, the escape – we can know our true source, the darkness that likely formed in our childhood and became, in eventual hopelessness, our soothing.

To value guns or knives, or bombs or poison, or sarcasm or cruelty, or superiority or hero-worship of a psychopathic former president, is to say "I need help." Unfortunately, the most forcible help we may seek is the symptom itself.

 

A confederacy of Jesuses

Imagine an entire psychiatric hospital populated by NGRI (Not Guilty by Reason of Insanity) paranoid schizophrenics whose main delusion is that they are Jesus Christ. I knew one such patient at the state psychiatric hospital in Columbus, Ohio. There, a game might be to picture two Jesuses on the same unit. How would each prove his case to the other? Would they remain pacifists or would they knock each other's teeth out? (Unfair: The schizophrenic I knew had no teeth.) Today, the present moment, I believe it is actually easier to imagine the whole hospital swarming with fantasy-dignified, strutting, high-minded, driven men (and a few women) who believe they are the Son of God, with benign and merciless power in their hands, swallowing then projecting (pooping out) as many wild beliefs as they could stuff in their cheeks, and enabled by the staff of underpaid bouncers who aren't permitted to question the psychotics' delusions.

This is, of course, our Republican government. We know the Democrats are the hobbled staff who must appease the patients, mutter authoritative words, and follow the rules. We see that the saying has come true: "The inmates are running the asylum." And some of us remember when psychiatric hospitals were considered remnants of the uncivilized past, the seedy mansions of horror stories. In the old days, paid tours would be given through the odorous halls, to see catatonics frozen in bizarre postures, the woman, regressed to infancy, playing with her feces, the angry screeching men.

See: We are still paying to watch them, the criminally insane, perform.