Get rid of "Borderline Personality Disorder" as a diagnosis

There may be very few people very interested in this topic, but I feel the need to write about it anyway. (It would appear that very few people are much interested in anything I write, but yet I soldier on). Here it is:  As a mental health professional for 30 years, I came to work with many women, (all women I might add) who I or someone else gave the diagnosis of "Borderline Personality Disorder".  Over the many years of my practice, in many different settings I kind of became known for working well with those with that diagnosis, behaviors, life experiences.  People would refer to me, as most professionals in the heyday of my practice, didn't want to work with those with this dreaded diagnosis. They were thought of as difficult, manipulative, unwilling to change, etc, etc, etc.  Well, then here comes Marsha Linehan in the late 80's or early 90's, who gave me a whole new way to look at all this "borderline" business.  Much more compassionate and forgiving than say, Kernberg, Kohut and that ilk.  Let's pause for a moment to reflect on the fact that it was almost 100% men who came up with the diagnosis to begin with.  That and practically all the early mental health diagnoses. 

Anyway, Linehan was coming from a more spiritual, actually Buddhist, point of view.  Her theory of the origins of the behaviors and life experiences were more rooted in early childhood experiences than the psychodynamic hoo haa of the Kernbergs and others. Finally there was a way through.  Basically the approach to the therapy with these individuals was to help them to find that elusive "middle way" in all things.  A fairly cognitive approach.  Teaching skills, the concept of "wise mind" (the blending of "reasonable" and "emotion" mind), teaching the person to recognize feelings, and the therapist always searching for a balance between acceptance and support and the push for change.  Always the "middle way". 

Since I have retired, I have continued to reflect on this "diagnosis".  I have come to the conclusion that the diagnosis of "Borderline Personality Disorder" needs to be eliminated from the DSM (the Diagnostic and Statistical Manual used by every mental health professional who bills insurances).  Here is why I think that: I have come to believe that almost all women of the boomer generation or before, in at least the white culture, have been raised to develop what came to be known as "Borderline Personality Disorder". I can only speak for my culture. (Interesting to me that I never saw those behaviors and life experiences in any of the refugee women I worked with in the last 10 years of my career). I can't speak well for African Americans, Latinos, Asian or Native women.  For good or ill, my practice, until I started working with refugees, was with white people predominantly.  I think that most of those women, as girls were raised to not think, feel or talk. I know I was.  Not so much because of the way that I was parented in early childhood.  In fact, I think I was parented pretty well by two people doing their best.  In my case it was my mother's alcoholism  later in my childhood that taught me to ignore my own thoughts, repress my feelings, and never speak my mind. Because of that reality, I have my own "borderline" behaviors having to do with repressing feelings that later sneak up and explode on me and others, having difficulty with speaking my mind to the people in my life it is most important to do so and other behaviors that I have had to confront and work on up to this day.  It is my opinion that most white women of the boomer generation or before were raised this way in varying degrees of severity.  The girls who were raised in the most repressive environments were the ones, as women or teens, who showed up in my practice leading desperate lives of broken relationships and emotional chaos.  

The term "Borderline Personality Disorder" sounds so harsh and ominous. Borderline what, anyway? I actually think the early theorists thought it was borderline psychotic.  In other words, that anyone with this diagnosis could "break through" the border between not psychotic and psychotic.  The behaviors and inner experience of these individuals was thought to be so crazy and erratic, I guess, that "borderline" was the best way those theorists could put it.  But if we look at the behaviors and inner experiences of those afflicted with this life problem, to me it has come to look like the person's spirit was broken by early life experiences and the broken relationships and chaotic emotions and thoughts are the person's attempts at trying to make their life work.  But of course it never works if you are going at life not knowing your own emotions, not able to find middle ground, feeling you can't be heard or understood unless you express things in the most extreme way.  You wind up driving people away from you and being thought of as difficult.  I believe that what we call things in the mental health profession is very important. How we think of the people who come to us for help is even more important.  I propose that we rename this life problem "Broken Spirit Syndrome". Or make it a subset of Post Traumatic Stress Disorder, the complex variety and take it out of the personality disorder context entirely. And I mostly think that therapists who work with women with these types of life problems look to themselves and their own "borderline" ways of being in the world to de-stigmatize  their clients' suffering.   I think that Linehan herself has come out of the borderline closet.  

So there are my thought this fine summer morning.