Playing pretend: Dissociation and BPD
Why those with personality disorder use pretend mode to escape a life that’s too real.
Traumatised children will reenact traumatic events through play. An original observation first made by Sigmund Freud at the turn of the 20th century contains an important lesson for individuals with BPD: In a crisis it’s all too easy to escape into fantasy.
This escape has been labelled pretend mode and it refers to a way of viewing the inner world as if it has no bearing on outer. Via a process of cognitive decoupling, a BPD patient can talk about mental states; that is to say they can talk about thoughts, feelings, beliefs, motives and desires, however they can’t connect them to the reality.
Childhood fantasies
Infants see the inner world and outer world as having equal status. Indeed in a process called psychic equivalence, babies subordinate physical reality to the mental reality. As a result monsters of the mind suddenly turn real; the a pile of clothing in the wardrobe, suddenly becomes a clawing apparition.
The fact that children see their own mind as synonymous with the mind of others, is no mystery. Babies are born, unable to differentiate their own body from that of their mothers. While awareness of their own physical integrity begins around the three month mark, knowledge of one’s own mind arrives later, and is the result of successful mother-infant bonding.
If mothers ar able to adequately mirror; their child’s facial expressions, secure attachment is the result. However, there’s a catch: Mirroring has to be congruent, meaning it has to match, but also marked meaning the facial expression has to be replicated but not the emotion itself. The result is a burgeoning sense of self, and growing awareness of different mental states, moods and emotions. Simply put, a self is born in the eyes of others, and while mentalisation is the belated result, to begin with babies assume the facial expressions they observe are identical to how they feel.
Needless to say, even if mirroring is successful, it’s all a little scary and to supplement this self-education, a child will use play as a way to test out different affects. An angry warrior, a swooning princess, happy prince, or fearful prisoner, all are examples of pretend mode: Away for children to represent different mental states abstracted from real life consequences. When mental states are integrated, pretend mode is largely abandoned for more sophisticated operations.
Adult Nightmares
Adults with BPD also use psychic equivalence to understand the world around them. An insecure attachment, based on a failure in mirroring leads to a wider failure in mentalisation, creating an unrelenting crisis, of emotional, cognitive, and behavioural instability; and subsequent problems with relationships and self-identity. The protective mechanisms which regulate the mind and body are missing and a person remains raw and shell-shocked. As a result compensatory measures based in childhood emerge once more.
Monsters of the mind once again become real: The person with BPD projects the contents of their own mind out onto the world. At the extreme end is the flashback, a nightmare visions experienced in broad daylight. However more subtle states also abound; individuals using psychic equivalence will assume if it’s true for them, it must be true for everyone else. Feelings become facts, and observable outcomes become more important than unseen causes.
Like in childhood, psychic equivalence is terrifying. To cope, those with BPD will revert to pretend mode, playing with mental-states as concepts rather than full-bodied realities; the inner and outer-world no longer match. It’s thought while psychic equivalence predominates in times of crisis, pretend mode is the default setting in daily life and for those with personality disorder a shield against unbearable pain.
A bridge to nowhere
- An individual who can talk about despair, distress, pain and suffering with a smile, and flat unassuming voice.
- The patient who undergoes years of psychotherapy, talking extensively about out of control emotions and behaviours, but never seems to overcome them.
- The service-user who acts as if the acts of self-harm are not harmless, or otherwise good because it it helps numb pain.
All examples are suggestive of pretend mode: Mental states, thoughts, feelings, memories, dreams, reflections, are abstracted, decoupled, cut off from their real-world implications. Ideas and concepts are unable to bridge the gap between inner and outer realities. All of this can be likened to a defense mechanism to ward off the terrible sense that what exists in my mind, must be the true everywhere else. Sometimes it’s a case of self-deception: the patient who denies substance abuse is damaging because it provides a useful distraction. Other times it’s experienced as a distortion: Drinking is good! Because it will lead to death, which in any event will be a better outcome than life. Either or, all are attempts to stop reality breaking in.
Pretend mode leads to pervasive states of dissociation and offers a compelling explanation for the BPD symptom of emptiness. In dissociative states of mind, where thoughts don’t correspond with feelings, and a person acts as if their inner world was no longer dependent on the outer one, self-harm becomes possible, even likely.
Living out recovery
Pretend mode is equivocal to British Psychologist Donald Winnicott’s false self, a dry, dead lifeless persona which buries the true self, the seat of all life and spontaneity in a deluge of intellectualisations. It is also similar to DBT founder Marsha Linehan’s idea of inhibited grieving, that is to say, suffering which is consciously or unconsciously suppressed, hidden beneath a mask of apparent competency. It is this dissociative state of mind, which begs the question, what is so bad about experiencing a sense of self which has it’s own unique physical and psychological integrity?
The answer is nothing — unless you’ve experienced trauma. If you’ve experienced childhood maltreatment, abuse or neglect, you’ll likely experience yourself as inherently bad. This sense of badness can be externalised onto another, whereby you unconsciously force another person to take on the role of persecutor in a process known as projective identification. Or you can introject that role and use self-harm as a means of punishing yourself. Finally you can block it off via pretend mode: Ideas are abstracted, turned inside out and upside down.
Often recovery becomes just another concept; just another idea to play around with, but in reality recovery must be lived rather than spoken about. The pretence of pretend mode is broken when you allow yourself to experience whatever it is your feeling. Easier said than done; the habitual response is to dissociate, to shut-down suffering at the point of origin. A therapist can help you. By eliciting an emotion, and then extracting it from the hardshell of fantasy, you are forced to confront what you’ve longed to forget. In a safe enviroment with a trusted advisor who can serve as a container for the strong affect this is an admirable way of getting better.
The bridge can be rebuilt; the self can become real. You’ve heard it said life is not a game — pretend mode can be devestating. However, when you get better, you’ll retain a sense of playfulness, only this time you’ll be sincere.
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