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The Wisdom of Psychopaths
In this engrossing journey into the lives of psychopaths and their infamously crafty behaviors, the renowned psychologist Kevin Dutton reveals that there is a...
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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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21 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.
For those of you who are doing things like comparing people with a BPD diagnosis to Hitler, saying they pose a huge threat to society, and the only thing that will stop them is death: Did it occur to you that someone with a BPD diagnosis may have read this article because they are searching for hope that they can get well, and that they might have seen your comment? Please understand that people with BPD do feel pain and that most of them can read. You have done exactly what you are accusing BPD sufferers of doing: you have inflicted great pain. Don't throw stones if your house is glass, as they say.
Reply | Report Abuse | Link to thisDuva306, you and Cluetrain mean well but it's a waste of time talking to these bigots. They don't know what they're talking about and what's that old adage about "a little knowledge is a dangerous thing"? Altho I'm not sure such wonderful, caring people as Camera5, Bops, and Dolly13 have even a LITTLE knowledge about BPD--their mud-slinging ignorance would indicate that actually they have NO knowledge, which is the most dangerous thing of all.
Reply | Report Abuse | Link to thisAfter all, Camera5 informs us that ppl dx'd with BPD "pose a threat to everyone around them", Dolly13 shares her wisdom that if someone thinks she has a problem and wants to change, that is proof that she does NOT have a personality disorder...excuse me while I catch my breath, I'm laughing too hard to type. I wonder where dear Dolly got her psychology degree? Definitely not where I got mine, she would never have made it thru the program!! And then there's old Bops, who so kindly tells us that "Death is probably their only stopper." (I guess he means death is the only way to stop "them"--you know,those dangerous borderlines-- but it's hard to translate such mangled grammar.) What do you suggest, Bops? Line all ppl with BPD up against a wall and shoot them? Or, since "they" are apparently no different from Hitler, Stalin, Saddam etc, how about a good old Nazi gas chamber? That would show 'em! Of course it would be a bit of a problem, since YOU then would be behaving exactly the way Hitler etc. took care of HIS little problems...but I doubt if any of you would lose much sleep over something that insignificant. After all, you're doing it to protect society, right? So that makes it okay. Hitler would be so proud of you all: Camera5, Bops, Dolly13 and the rest of your ilk. Just a couple of closing thoughts:(1) have any of YOU ever been tested for Borderline Personality Disorder? I'm noting several worrying traits....(2) Re: Hitler, Stalin, Saddam etc, besides looking up the usual suspects (sociopath, Antisocial PD, psychopath) try looking up something called MALIGNANT NARCISSISM. With a lot of luck and even more effort, you just MIGHT learn something.
Bucket: I just saw your comment today. It was here: http://www.nytimes.com/2011/06/23/health/23lives.html?pagewanted=all&_moc.semityn.www
Reply | Report Abuse | Link to thisYou might see Alsta's comment above, regarding DBT and Dr. Linehan.
As a woman of "limited" faith, who believes the universe is not set out to destroy us, who also was labeled...I find it refreshing that mindfulness is healing.
I'm really disappointed by some of the comments here. BDP is basically a condition that makes one extremely sensitive. How someone handles those intense emotions is a reflection of their own awareness, moral judgement, and perception rather than to be blamed on the condition itself. I was recently diagnosed with this condition and am a very kind person that just feels a tremendous amount of emotional pain. I am a survivor of horrific abuse and am trying to be healthy. To survive something so horrible is unbearable at times, but the lack of compassion many have for people with emotional problems is beyond disturbing. Just because one person you knew had this condition was a horrible person doesn't mean that everyone else with this condition will be the same.
Reply | Report Abuse | Link to thisYes, hardly scientific. Snake oil salesman is all. I'd like them to come and talk to me and my kids, and hear the horrors of hell their father has put us through (emotional, spiritual, safety, physical abuse, stalking). Personality disorders ARE their personality. They are NEVER removed. I have no respect for Linehan, she is the biggest snakeoil salesman of them all. It didn't take courage, it just took a lot of lying, something BPDs are all too good at. These people are absolutely totally destructive to ANYBODY and anything close to them. The monetary loss (law enforcement, courts, social services, lost jobs, lost sleep leading to safety issues, accidents, etc.), the total soul killing they do. They should be institutionalized with a lockdown door at all times. Much better for society.
Reply | Report Abuse | Link to thisYeah, these 'experts' cannot even tolerate more than a few therapy session with them, at which point the BPD will split them faster than a banana split, project, deny, rage, lie, gaslight, self-harm, harm someone else. Insanity doesn't do this justice.
Reply | Report Abuse | Link to thisCluetrain, you need to catch a clue. NO, BPDs will never admit something is wrong with them. There is something wrong with you (projection is their fave defense mechanism). Obviously, you've never been in a divorce with an Axis II cluster B diagnosis. OMG! You need to wake up and read the horror stories of what the NONs and the kids go through, and most of it court-sanctioned by the way. Find out how many murders are committed by BPs involving custody disputes. Don't harp about something you know nothing about. Yes, BPs LOVE to harm others. They were hurt as kids, they lash out at anybody close. I hate you, don't leave me. And you have NEVER felt that hate, and I wouldn't even wish it on Hitler. And that lady did not say Hitler was BP, but it is very obvious he did have ASPD/sociopathology, which most men who are BPs also have. Don't speak about something you've briefly read about, but never become an expert at my having to LIVE with it for 18 years.
Reply | Report Abuse | Link to thisHonestly, I find some of these comments to be fairly ignorant about BPD. BPD often co-exists alongside other disorders, so perhaps the people you've dealt with have other problems that cause them to act the way they do. I am a survivor of childhood and adult physical, sexual, and emotional abuse. I am also a staunch feminist, a Ph.D. student, and an Ivy League graduate. In addition, I am borderline. I am extremely emotionally sensitive and undergo more pain in a day than I can describe. Sometimes I feel like I am living in Hell because of the night terrors, anxiety, emotional trauma, and pain I experience on a daily basis. Has this sometimes jeopardized my relationships or made it hard for me to relate to people? Certainly. Has this made me abuse children, develop a lifestyle similar to Hitler or Stalin, or purposely destroy other's livelihoods through divorce? No, it has not, and though I'm sorry that you are bitter than you lived through certain experiences with certain individuals, it was because you made poor choices or were deceived and ended up with terrible human beings. It was not because of their personality disorder, particularly this one, which causes more personal pain than can ever be externalized. But your selfishness and anger is causing you to lash out at people who don't deserve it and who already experience a great deal of pain simply by existing in their own minds and bodies. So please stop with the stigmatizing. Own your own problems and your family's problems. I promise you, they aren't because of a diagnosis in the DSM-V.
Reply | Report Abuse | Link to thisthat* not than; others' not other's.
Reply | Report Abuse | Link to thisAlso, if I'm such a threat to society, why have I never committed a crime? Why do I have so many friends? Why am I able to hold down jobs, maintain relationships, and work on my personal problems--particularly those related to borderline--if I just "can't" understand them due to my pervasive disorder?
I mean to be harsh. I do, because I can only assume that you don't understand that you are deeply harming and wounding others with your prejudiced one-case-study opinions. Your personal problems are your business,and your personal experiences are valid. But you are truly hurting others who already have mental problems based on single experiences. Please, for their sake, have some degree of compassion and stop.
I have BPD and admit something is wrong with me, therefore your entire theory is blown.
Reply | Report Abuse | Link to thisHonestly, your comments are abusive and extremely discriminatory. I am sorry about your bad experience, but that does not, in fact, make you an "expert" on BPD. That makes you an expert on your ex, who admittedly sounds like he sucks. Nothing else.
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