‘Personality Disorder’ is a pejorative label that is letting service users down.
To be fair, credit must be given to the psychoanalysts. In the early 20th century they were the first to coin the term ‘borderline,’ but also the first to treat it.
Since then, psychiatry has supposedly moved forward. However, the DSM -the bible of mental health - continues to codify conditions like Victorian taxonomists. A checklist of symptoms, does little to address the complexity inherent to many illnesses.
After all, mental health, is not subject to the same laws of traditional medicine. At the base of almost all psychiatric problems, is the sense of not fitting in. This interpersonal dynamic is also at the heart of ‘Personality Disorders’.
As humans we are born under the evolutionary imperative to seek out attachment. As babies we cry, smile, and cling as a way to elicit our mother or fathers attention. When this attachment is reciprocated children are more likely to grow up healthy and happy. However, if the attachment system fails it causes long term problems. Unfortunately children who grow up with negligent parents, will still attach themselves, as a matter of survival.
‘When children feel pervasively angry or guilty or are chronically frightened about being abandoned, they have come by such feelings honestly; that is, because of experience’ John Bowlby
Pop psychology says BPD patients lack empathy. This another ridiculous statement that stigmatises the condition further. It’s more complicated than that. If a child grows up in an invalidating environment where the healthy expression of emotion was exploited or suppressed; he or she will go into adulthood unable to feel safe or secure in the world.
‘Mentalisation’ is the ability to create mental representations of yourself and other people using mindful awareness and imagination. It is a skill learnt from the earliest days of our life. Beginning in the bond between mother and baby when they look at each other. Mirror neurons help parent and child reciprocate each other’s facial expressions and feelings. This is why psychologists call it ‘mirroring.’
As time goes on the process becomes more sophsticated and mirroring becomes ‘mentalisation.’ Children and parents are able to contemplate each other as seperate beings and a healthy attachment develops.
For people with BPD, the process of mentalisation has been compromised. In essence, the sense of who we are, our place in the world, and our ability to ‘see’ emotions objectively, depends on whether as infants our own mind states were adequately understood by caring adults.
‘I still regurarly get scientific papers to review that say things like “it’s been hypothesised that borderline patients may have histories of childhood trauma.” When does a hypothesis become a scientifically established fact?’ Bessel Van Der Kolk, MD
Right now, many young people are being let down by the health services. In the UK it is illegal to label anyone under the age of 18 with a personality disorder — and yet we don’t mind diagnosing them with autism, schizophrenia or OCD. The intention of course is noble: They don’t want to consign young patients to the dustbin of diagnoses. And yet it leaving young people ill equiped to deal with the chaos within. How much suffering could be avoided, if these problems was treated early.
For real progress, we need to relabel BPD with something more accurate. This is why there are now calls to name it Developmental Trauma Disorder. This not only aknowledges the problems of failed attachment bonds but has a wider impact on society.
‘There is no coming to consciousness without pain….One does not become enlightened by imagining figures of light, but by making the darkness conscious.’ Carl Jung
After all, broken homes are a social problem and need to be addressed with firm insight. Children become adults, and they end up in prison cells, psychiatric wards, hospital beds, or of course failed parents themselves. Not only are they not being treated, they are also insulted with meaningless names.
And yet even with a broken mirror it is still possible to gather these fragments and begin healing. The bonds that have shackled us are also the ones to that in another life, that will help us be free.