Love’s the Best Medicine: Recovering from BPD without the need of therapy
and how emerging from emergency has everything to do with learning how to trust.
In 1938 Austrian-American psychoanalyst Adolph Stern discovered Borderline Personality Disorder — or rather named it. Perplexed by a very sick group of patients, he found their symptoms so extreme that he considered them half-mad: On the “border line” between sanity and insanity. Their chronic instability, in his words, were the result of ‘not being or having been sufficiently loved in childhood.’ Nearly 100 years it turns out Stern was wrong about prognosis but right about the cause.
What’s love got to do with it?
New research spearheaded by British Psychologist Dr Peter Fonagy has revealed Borderline Personality Disorder has its roots in insecure attachment. A failure of mother and infant mirroring: the process by which facial expressions are seen and reciprocated, leads to a wider failure in Mentalisation: The ability to infer the mental-states within our own minds and the mind of others. This leads to an incoherent sense of self, and subsequent cognitive, emotional and behavioural instability. The self is born in the eyes of others, and without secure attachment it’s not born at all.
Attachment is biologically hardwired, and via a set of instinctual behaviours such as crying and clinging infants will naturally form emotional bonds with their caregivers. What was once considered a rudimentary mechanism of survival is now known as an important regulator of emotions, cognitions and sense of self. Babies who are securely attached go on to be happy and well-adjusted, those with insecure attachment don’t. In fact they are at high risk of developing mental health problems. When insecure attachment is paired with trauma, the chances of acquiring BPD are high.
Where do broken hearts go?
Imagine life, seen as if through frosted glass. Swirling in a vortex of misunderstanding, mentalisation deficits, make it feel as if you're a ghost looking into the houses of those still living. Exiled and perpetually locked out, relationships are stormy, violent and short-lived or completely non-existent. Adults who can’t mentalise sufficiently end up hyper-mentalising: obsessively analysing their own mind and that of others in a state that resembles paranoia. Alternatively, they will not mentalise at all, more akin to dissociation. As a result human connection feels impossible.
Furthermore, in BPD the attachment system is disrupted. Hyperactive or inert; the sufferer swings like a pendulum between wanting to be close to others and wanting to be alone. There’s a desperate need to cling to the remnants of your own humanity, which is only experienced as real when in the presence of others. However, to have that very same humanity shattered by abandonment, leads to withdrawal, and loneliness.
The inner journey to salvation
Recovery begins when a person regains their Mentalisation skills; that is to say when they reacquire the ability to infer and imagine their own thoughts, feelings, motivations and desires and the thoughts feelings motivations and desires of others. You do not have to be a stranger in this world any longer.
When Peter Fonagy and Anthony Bateman began developing Mentalisation-Based-Treatment in the early part of the 21st century; they did so believing Mentalisation deficits where at the heart of the BPD diagnosis. If a therapist was able to elicit the patients reflective capabilities by building a therapeutic relationship based on trust, honesty, warmth, and kindness recovery was possible. It now turns out MBT works: It’s simple, cost-effective, and clinical trials demonstrate high rates of efficacy. More so it allows patients to think about their own minds, and the mind of others via real-time interactions.
Perhaps you couldn’t bear to look? If you’ve been hurt, abused or invalidated, you might be scared to imagine what other’s are thinking. On the other hand, maybe you over-analyse people, desperately trying to predict their next move. Those with BPD, often consciously or unconsciously end up sabotaging relationships with friends, families and partners; when the idea of new love becomes a life or death proposition, the mind starts to flounder. MBT is a way to learn how to trust. However, you may not need therapy if you have supportive friends and family.
Love is all around
Which brings us back to Adolph Stern’s original assumption. These patients – these individuals torn up by the illness called BPD — appear on the ‘border line’ of madness, because they’ve been exiled to the borderlands of love.
And yet, Fonagy once called ‘Mentalisation’ a ‘silly’ word,’ a word he coined to give a simple skill the air of scientific respectability. Because what is Mentalisation really? Simply put it is the ability to see clearly: To not be locked out or locked in, but to live and participate in the world completely. This is only possible through loving relationships.
Recovery can be reached without therapy when the mind senses it’s no longer alone: This is only possible through relationships. All it takes is trust, trust gained from the kindness of friends, family, partners or loved ones. If we have a network of people who genuinely care about us, who are interested in our subjective experience, our thoughts, feelings and desires then we begin to find the world a little less scary and begin to re-engage with it. As Fonagy states:
There needs to be a set of relationship that are mentalising. Mentalisation is just a silly word for saying that they [individuals] feel understood, treated as agents, taken seriously, and that decisions are shared with them and not simply made about them; where another person becomes interested in their subjective state sufficiently for them to start feeling trust of that person, and which enables them to open their mind to a completely different way of looking at the rest of their lives, this is ultimately curative. I can imagine even without a therapist, a change in social enviroment can move a person from a situation of mistrust to a situation of trust, where they are once again open to the social world around them. To me it’s that movement which actually generates recovery […] and there we are — That’s it. That’s all there is. I as a therapist can do no more.
The light of others
Adolph Stern decided those with BPD were untreatable; because when viewed through the prurient puritanical eye of Freudian psychoanalysis that’s exactly what they were. However so many of the myths surrounding this ‘dustbin diagnosis’ – including the idea of a poor prognosis, arose from physicians who didn’t care enough to be interested. It was theory without substance. Because, after all if patients were sick from having not been sufficiently loved in the past, surely they could get better from being loved sufficiently in the present? Acquiring such love, through relationships may be difficult – we may be very sick, and scare others away or keep ourselves apart – but it’s not impossible.
A radical change to the social environment: a new relationship; a new set of friends; a complete network of mentalising adults, and a new world may open up. This emerging from emergency without the need of therapy; a recovery based in real-life. The bonds we form with others, are the looking glasses in which we see ourselves. True, complete, unified, and worthy of this life, and love contained therein. Imagine that…