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The Wisdom of Psychopaths
In this groundbreaking adventure into the worlds of psychopaths, the renowned psychologist Kevin Dutton argues that there is a fine line between a brilliant...
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This past June renowned clinical psychologist Marsha M. Linehan of the University of Washington made a striking admission. Known for her pioneering work on borderline personality disorder (BPD), a severe and intractable psychiatric condition, 68-year-old Linehan announced that as an adolescent, she had been hospitalized for BPD. Suicidal and self-destructive, the teenage Linehan had slashed her limbs repeatedly with knives and other sharp objects and banged her head violently against the hospital walls. The hospital’s discharge summary in 1963 described her as “one of the most disturbed patients in the hospital.” Yet despite a second hospitalization, Linehan eventually improved and earned a Ph.D. from Chicago’s Loyola University in 1971.
Many psychologists and psychiatrists were taken aback by Linehan’s courageous admission, which received high-profile coverage in the New York Times. Part of their surprise almost surely stemmed from an uncomfortable truth: people with BPD are often regarded as hopeless individuals, destined to a life of emotional misery. They are also frequently viewed as so disturbed that they cannot possibly achieve success in everyday life. As a consequence, highly accomplished individuals such as Linehan do not fit the stereotypical mold of a former BPD sufferer. But as Linehan’s case suggests, much of the intense pessimism and stigma surrounding this disorder are unjustified. Indeed, few psychological disorders are more mischaracterized or misunderstood.
Fuzzy Borders
New York psychoanalyst Adolf Stern coined the term “borderline” in 1938, believing this condition to lie on the murky “border” between neurosis and psychosis. The term was a misnomer because BPD bears little relation to most psychotic disorders. The name may have perpetuated a widespread misimpression that the disorder applies to people on the edge of psychosis, who have at best a tenuous grasp of reality. Not surprisingly, the popular conception of BPD, shaped by such films as the 1987 movie Fatal Attraction (featuring actress Glenn Close as a woman with the condition), is that of individuals who often act in bizarre and violent ways.
An error committed by some clinicians is presuming that patients who do not respond well to treatment or who are resistant to therapists’ suggestions are frequently “borderlines.” Some mental health workers even seem to habitually attach the label “borderline” to virtually any client who is extremely difficult to deal with. As Harvard University psychiatrist George Valliant observed in a 1992 article, the BPD diagnosis often reflects clinicians’ frustrated responses to challenging patients.
In reality, BPD is meant to apply to a specific subgroup of individuals who are emotionally and interpersonally unstable. Indeed, Linehan has argued that a better name for the condition is “emotion dysregulation disorder.” Much of the everyday life of individuals with BPD is an emotional roller coaster. Their moods often careen wildly from normal to sad or hostile at the slightest provocation. As Linehan pointed out in a 2009 interview with Time magazine, “Borderline individuals are the psychological equivalent of third-degree-burn patients. They simply have, so to speak, no emotional skin.” Their perceptions of other people are inconsistent, and they often vacillate between worshipping their romantic partners one day and detesting them the next. Their identity is similarly unstable; patients may lack a clear sense of who they are. And their impulse control is poor; they are prone to explosive displays of anger toward others—and themselves. [For more on the symptoms, causes and treatment of BPD, see “When Passion Is the Enemy,” by Molly Knight Raskin; Scientific American Mind, July/August 2010.]
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10 Comments
Add CommentSo much to discover when reality is what society imposes at various times and place. A psychotic in one era may exist as closer to normal in another.
Reply | Report Abuse | Link to thisThe impossibility of knowing everything in a persons head, the severity and relevance. All of us are inconsistent to some degree, and all play to each others personality that situations are unique to each individual we encounter.
The BPD/EDD personality may be affected more intensely, that they perceive more acutely the inconsistency in others and (possibly themselves) the change is too drastic for them to handle calmly.
Marsha M. Linehan was healed by a power that gave her the ability to love herself, to see herself as worthy. Previously, she was self-detesting and felt undeserving of life. There is no drug that can do that, no therapy. The power of love is one thing, thank God, that Psychiatry can't mess up.
Reply | Report Abuse | Link to thisI'm just saying...
Marsha wrote an incredible book regarding DBT (Dialectical Behavioural Therapy), which has been found to be an effective treatment for Borderline Personality Disorder.
Reply | Report Abuse | Link to thisSorry Rosabw, but although I agree that drugs are often used too liberally, I disagree with your ideas of therapy assisting with helping one see themselves as worthy.
I'm not sure if you know much about DBT, but it's all based around being mindful of your life, and learning how to regulate your emotions, communicate with others effectively and tolerate extreme bouts of distress, anxiety, pain - any exteme emotion - which come along with the diagnosis of Borderline Personality Disorer.
Unlike Freud's classic psychodynamic therapy, DBT does not merely exist as a tool for one to analyse another's thoughts, from their own perspective. It is a more give and take role between client and therapist.
I suggest you check it out, it makes good reading - not just for those with BPD, but for anyone who struggles with their emotions (i.e everyone.)
Both authors are professors of psychology but neither mention 'high functioning borderline' a term which is current in the literature on the subject. The fact that someone is able to perform at a high intellectual level does not mean that they do not have BPD or that their BPD is under controlled or cured. In fact the very reason that so many BPD people of both genders are able to run companies and even countries is part of why this disease is of such interest. BPD are driven by an overwhelming need to control, fear of abandonment and they seldom give up. Their ability to empathise can wholly deceptive, spilling tears over emotional ephemera while meeting death with ice cold indifference.
Reply | Report Abuse | Link to thisI wholly disagree with the tenet of this article that BPD is really not that bad. Of course misdiagnosis is a problem in physical and mental health but overall the problem is that we do not pay nearly enough attention to the damage caused in society by BPD. It is precisely because BPDs are so skilled at hiding their destructive behaviour and sowing confusion that they pose such a threat to everyone around them.
To say "Nevertheless, the extreme negative views of this condition are undeserved..." is, in my view, nonsense. It is the elite view of a mental health insider constantly reading the literature and discussing the condition with colleagues. In society at large not nearly enough is known this 'personality disorder', diagnoses are woefully missing and the sheer horror of living with a BPD mother or boss or partner are massively underestimated.
I agree with you, "massively underestimated" is too polite.
Reply | Report Abuse | Link to thisDeath is probably their only stopper.
WARN other people...even if they think "your wrong about the person", this might alert them enough to think ahead and protect themselves.
Learn the warning sign, get help, and take appropriate legal action if needed. These people are Tough!
First off, Valproate is rarely used as a mood stabilizer these days. Lamotrigine and other newer anti-seizure medications are used.
Reply | Report Abuse | Link to thisSecondly, there is a LOT of research data out there that substantiates DBTs usefulness in changing BPD behaviors, and helping Borderlines to live fairly normal lives. In fact, the data is so strong toward the usefulness of DBT that it is being used extensively in treating addicts.
Thirdly, @ Rosabw: Marsha Linehan had to work just as hard and practice, practice, practice as any of us who have BPD, to learn to accept and love herself. This is not to discount God's graciousness and kindness. But God doesn't change our personalities. Believe me, I've begged him to change mine for decades, even before I knew of personality disorders.
And lastly, regarding the citation, "Work by psychologist Timothy J. Trull and his colleagues at the University of Missouri–Columbia similarly suggests that many young adults who display some features of BPD do not exhibit these features after only a two-year period, indicating that early signs of BPD often abate." It is well known that many adolescents (or "young adults") exhibit "some features of BPD" throughout their adolescence, and for most of them, those behaviors diminish as their brains become fully developed.
However, a person with a true Borderline personality does not improve on his or her own - it is part of their personality! It takes medications and years of hard work through therapy and practice. The work to change one's behavior so that is is socially acceptable and as close to "normal" as possible can be exhausting. Yes, the outward signs of BPD diminish with age, but we're talking about improvement showing up in one's 40's and 50's.
Yes, as Camera5 said: "...the sheer horror of living with a BPD mother or boss or partner are massively underestimated."
Reply | Report Abuse | Link to thisAnd yes, as Cheri74evr notes: "It is well known that many adolescents (or 'young adults') exhibit 'some features of BPD' throughout their adolescence, and for most of them, those behaviors diminish as their brains become fully developed."
That means...those adolescents and young adults didn't have BPD. They didn't have a personality disorder.
If someone "gets better" from BPD it means he or she was misdiagnosed. I've known many people with "real" BPD and although they might -- might! -- mellow a bit with age, they do not as a rule "get better" -- they don't even think there's anything wrong with the way they behave, so they have no motivation to change.
If someone with BPD-ish symptoms thinks she has a problem and wants to change, then she doesn't have a "personality disorder" -- that's part and parcel of the definition of "personality disorder."
I had a strongly negative response to this article -- almost an angry response (!) -- because often, the people who find themselves at the mercy of people with BPD -- the spouse, the kids -- have a false belief that the person with BPD can change. It's not going to happen. And it's so much work for these folks -- it takes so much time for them -- to realize that it's not going to happen -- and then an article like this waltzes in -- with the seal of approval of a respectable scientific publication -- and it says "Heck it's not so bad, and Linehan experienced a miracle cure, and you know, maybe people with BPD can get better."
As a general rule, they do not. That's what the scientific evidence shows. They do not.
Thanks a lot, Scientific American.
Dolly I agree. This article flies in the face of so much research and literature on the subject that it calls into question the reliability of the authors and their motives. Why are these guys trying to downgrade BPD when we need to increase our vigilance over this serious illness which is a destroyer of lives - sometimes on a vast scale? Hitler, Stalin, Mao, Gaddafi - its abstract when its tens of millions but its hyper real when its one person in your immediate family!
Reply | Report Abuse | Link to thisPlease cite the source for your statement. I found nothing in the article supporting your statement.
Reply | Report Abuse | Link to thisWay to promote stigmatizing stereotypes, Camera5. Why not add Count Dracula, Cruella deVil, and Wile E. Coyote while you're at it?
Reply | Report Abuse | Link to thisPlease cite the source of your claim that, in the pool of people who have been diagnosed with BPD, "many" of them are running companies or countries... and also your statement that 2 of the characteristics of BPD are an overwhelming need to control, and tenacity.
Experts have NEVER come to a consensus about what, if anything, was Hitler's diagnosis. Of the 9 criteria for BPD, per the DSM IV, the only one that Hitler even came close to exhibiting was paranoia (and it wasn't transient and delusional). He did not have intense relationships; he kept his emotions hidden; he had a strong sense of identity, and well thought-out long-range plans (expect for a period of trying to "find himself" as a young adult); and by all reports he showed a pretty stable disposition. There was no impulsive or harmful behavior; he stuck to "clean" living (except for prescription meds from an overzealous doctor.)
Remember, BPD is a disorder of hurting inside, and not of wanting to hurt others. BPD didn't kill tens of millions of people-- power-crazed dictators did.
We can speculate all we want, but I'm betting that people who actually have BPD could tell us that they DO know they have a disorder, and DO want to change. Plus, unless you're a minor child of a PD parent, you're not at anyone's mercy. If you feel like a victim, leave.