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.

Bill Cosby and Atticus Finch and other sorrows

I find it interesting that we are grappling with two beloved icons falling from grace at about the same point in time.  I have only read the reviews of Harper Lee's book about carrying the news that Atticus Finch turned out to be a Ku Klux Klan member later in life. It's a little bit interesting that Harper Lee wrote this book first and then wrote "To Kill A Mockingbird", because she knew the way it would turn out in her story.  Truthfully, as much as I loved the book and,later, the movie, I have always felt a little bit uncomfortable with the image of Atticus Finch as superhero.  Defender of black men wrongfully accused of raping a white woman.  We white people have always wanted to elevate our role to a position of leadership in the long struggle for civil rights for black people in this country.  It has never been the case that white people have taken a role of leadership in this cause.  Not really.  Now white people, don't start sending me hate mail.  I know that many white people have stepped up and participated and even given their lives for the cause of civil rights.  That is not what I am saying.  I am saying that the role of whites in this has often been highly exaggerated in literature and movies, even as recently as "The Help".  So that Harper Lee morphed Atticus Finch into a racist jackass, that is a wonderful reality check for white people.  An unlikely morph in the real world I think.  But still it is fitting. Poetic almost.  Because we put too much onto the shoulders of our heroes.  We elevate them.  We capture them.  We limit them. I look forward to reading this part of Harper Lee's story.   

Then we have Bill Cosby.  Heroic black comedian, able to relate to whites because he was so non-threatening.  I guess.  He was funny and truthful and all of the things we want in a hero.  An icon.  And unless there is some outlandish miscarriage of justice going on before our very eyes, turns out he was also a serial rapist. Maybe a sex addict gone over the edge, at the very least.  It would be heartbreaking if it wasn't so vile. 

Seems like we mix up fiction and real life.  

Then in the meantime, we have President Obama showing up in Oklahoma to people waving the Confederate flag.  The ugliness of this is almost too much to be able to express in words.  President Obama has been subjected to the rawest, ugliest, nastiest kinds of racist bullshit from the very beginning of his term in office.  His family has not been spared from overtly racist comments. If this fact doesn't illustrate that we white people are so very far off from the Atticus Finch ideal, I am not sure what would.  We are haunted by the legacy of racism in this country. As President Obama said at his eulogy for the pastor killed in the recent massacre, it is our original sin.  

Yet I have faith that we will find a way through.  I do.  Maybe President Obama's term in office has served to elevate the issue to front and center, where it needs to be.  We can't correct a problem that we are in denial about.  We need to look at it square in the face.  I believe in the basic goodness of the human race. We will find a way.  We will.  

Well, well, well...ACA and Marriage for Same Sex Couples, the Law of the Land

Sometimes right just prevails.  Or maybe right prevails after people fight and sweat and protest and show up and take it to court and stand on their heads and many years pass, then right prevails.  But to have two such epoch rights happen within 24 hours of each other is really something to get excited about.  Yet, then we have the massacre in Charleston. And yesterday President Obama's eulogy for Clementa Pinkeney somehow squeezing some measure of hope out of the murder of 9 innocent people by a psychopath wrapped up in the Confederate flag.  Don't ask me how he summoned the guts and pure damn eloquence to do it, but he did.  And leading the people in attendance to "Amazing Grace"...wow, my peeps, it don't get too much more mind-blowing than that on a Friday afternoon.  May we somehow find a way to dig down deep in our souls and confront the legacy of slavery in our country once and for all.  It's killing this country.  It's killing young African American men every other week it seems.  We have a prison system that incarcerates in hugely out of whack percentages black and Latino men, which my friend, Joan, refers to as slavery, and she just may be right.  President Obama referred to slavery as our country's original sin. I've heard it put that way previously, but to have the President of the United States say it in front of God and world...wow and mercy.  So maybe the next right to prevail will be that.  It will be some kind of national spiritual upheaval that makes us look reality in the eye.  And do something about it.  Like for instance, if we recognize that our police officers carry our projected and denied racial hatred on their shoulders and act it out for us in shootings of unarmed black men, and instead, recognize that racial hatred in ourselves, maybe we will start getting someplace, white people. No offense, my fellow white people.  But really.  We got to own it and stop pretending racism is something of the past. And I do not mean by that that I, you, we go around saying "I hate black people and Latinos and Asians and Native people".  That ain't it, my white peoples, my tribe, my familiars.  It is recognizing that we have benefited from institutionalized racism that is the legacy of slavery.  Period.  That legacy has driven a psychic and spiritual wedge between "us" and "them".  And the "us's" are the ones that have to do something about it.  Start with yourself and go from there.

The other thing is this sudden upset with the Confederate flag.  As these things go, it is better than a sharp stick in the eye as a place to begin confronting our long history of racial hatred.  A Bill Moyers posting says it better than I ever could.  You may have seen it on Facebook or some other social media.  The author is a guy who grew up in Mississippi and knows of which he speaks.  I shall attempt to include the link here:

Why the Confederate Banner Must Come Down

That's it for now.  Let's create a world worth living in.

More on Bruce/Caitlyn Jenner

This is not a topic that I would think to write about out of a clear blue sky. But this whole thing that has been stirred up around Bruce Jenner becoming Caitlyn has just gotten me thinking about a bunch of stuff. I have identified myself as a feminist since my early 20's. Over all those years I have fought against the sexualization of women. Not that I have necessarily been in the streets about it. More in my own life and where I might have influence on other lives. It offends me and I think degrades women for Caitlyn to pose for Vanity Fair using all the bells, whistles and technologies available to her, the end product being a dolled up caricature of a woman. For chrissake, this is a 65 year old person. What the hell is the matter with posing as a 65 year old woman?? What kind of message is being sent to girls, boys, women and men by this ridiculous caricature? That the only kind of woman worth anything is a young, beautiful one?

The other part of this that really bothers me is that Bruce Jenner, now Caitlyn, has been a part of a family that has made celebrity into some kind of circus act. They have dedicated themselves to appealing to our very basest instincts such as greed, an obsession with "looking good" and other degrading bullshit. I get that it is a good thing for all of us that a famous person has come out as transgender. I just don't think that posing in this circus act way for Vanity Fair does one damn thing to "normalize" this variation on our humanity. It just makes it seem glamorous. So in other words, this, like all the other cheap antics of the Kardashians, is just another glamorous thing for the rest of us to long for and never quite achieve, gay, straight or transgender. I believe the harm this image does outweighs the good in the long run of things. What would have been so bad with being a 65 year old transgender woman, plain and simple? Instead we have an image that promotes self delusion and foolishness. And, believe me, I understand that Caitlyn gave up her youth playing the part of a man she didn't feel herself to be.

I want LGBTQ people to live in a world in which they can be people. Just people, not stupid caricatures. To marry, have civil rights, have children if they wish to. I want to live in a world in which sexual and gender identification is no longer some kind of a hot political issue. I wouldn't mind seeing the end to sexism and racism. I want a lot of shit that I probably won't live to experience. I'm just not sure that glamour poses on the cover of magazines does much to advance us toward those ends.       This is me, last year, age 65:

More this, that and the other thing

What with this, that and the other thing, I have neglected my blog of late.  I'm going to try to do better as Spring becomes Summer.  I am reading the wonderful Lila by Marilynne Robinson.  For those of you who have read this set of stories that were started with  Gilead and Home, you know what I am talking about when I say, "Gee whiz, what writing." It's just lovely prose.  Sometimes I just loose myself in the words.

Seems that my little world has changed since Steve and I returned from a trip back East.  Steve had his last day of work on March 27 and we left for Cape Cod on April 1.  We returned on April 16 and since then life has felt like it is screaming down a 12 lane highway at about 100 mph.  Just stuff, you know, but lots of it.  Then we both got sick for several days and here I am.  I finally feel ready to reflect on life, liberty and the pursuit of happiness a little bit.

Something very interesting happened while we were in Boston.  I am kind of sure that this sort of thing happens with a certain amount of regularity in big cities.  But for this Idaho hick, it was interesting and a bit disturbing.  We were on the T, which is what the subway is called in Boston.  First time for both of us.  We were on our way to visit the JFK Museum and Library.  Well, the doors close and right away this lady, standing in front of the door, starts yelling, "Please somebody give me $5.00". And then elaborates on why she wants the $5.00, something about her brother died in New York and she is trying to get there to go to his funeral. She just keeps yelling out her story and begging for the $5.00. Well, I look around me and everyone is just staring forward or looking a their phone.  I am the only person even looking at the lady.  I just sat there frozen between my compassion for this lady and my fear of being thought of as an idiot if I got up and gave her some money.  I am ashamed to say it, but it is the truth.  I get it.  It isn't going to exactly engender sympathy in others to stand in a subway car and yell at people to give you money.  But, man alive.  She was somebody's daughter.  And I just sat there frozen in my own ineptitude and fear.  She did bitch us all out when she got off the car at the very next stop.  She said, "Have a nice day, and I don't mean it!" or something like that.  Guess we all had it coming. Not one of humanity's prouder moments I guess.  She had some moxie, I'll give her that.  I wonder how much she made that day. She could have used a consultation on more effective ways to panhandle, I suppose.  But still.  Would it have killed me or anyone else on that car to get up and hand her a few bucks? Talk about your existential dilemmas. And if anyone was filming this little encounter for some college paper or something, we all flunked whatever the test was, including the lady yeller.  Anyway, one of those moments that makes life continually intriguing.

In the meantime we have Ferguson, Baltimore and God only knows what else.  Oh yeah, nut cakes yelling about how Obama is going to invade Texas or some damn crazy thing.  Steve and I just watched the movie "Selma" last night.  I thought it was very well done.  But I couldn't help thinking that we have gotten so short a way down the road to freedom and equality in this country.  The violence and mayhem visited upon the people who walked across that bridge 50 years ago is still going on.  Never stopped.  As much as we would all like to believe that things are better, they are not.  The pieces have just moved around on the game board.  Some of our police forces around the country have themselves caught in a big mess, fueled by racism, fear,  I don't know what all, that has led to a black citizens being shot dead.  As a person who has benefited from institutionalized racism, one of the things I can do about it is write about it here and show up where I can.  I intend to do that until I can't do it anymore.

I also just watched a PBS show on Kent State called "The end of the 60's". It made me realize that the  the simpleton mindset that developed during the Nixon era of "the folks who dissent are not real Americans" has morphed into something much more insidious.  It's this faction of the Republican Party that has become a cult of insurgents.  What used to be considered kind of far out cuckoo thinking has now become mainstream Republican party conversation.  Actual elected people are spouting utter nonsense like "Obama is going to invade Texas". Steve had a teacher in high school who was a famous John Bircher type, who at the time was correctly thought of as being cuckoo.  Well now that cuckoo lady would be welcomed with open arms into the bosom of the Republican Party.  I'm telling you, there is something festering in the Republican Party that allows this kind of insurgent mentality to emerge.  I just read an article by one of my favorite journalists, Leonard Pitts. I have enclosed a link to his article because he says exactly what I mean. The link is to an earlier article and there was  follow up article into today's Idaho Statesman.  Thank you, Leonard Pitts for articulating so well what I have been thinking on for a long time.

 Leonard Pitts Jr.: 20 years after Oklahoma bombing, hatred still out there 

Depression and the wrong headed notion that it would cause someone to fly a passenger jet into a mountain

I just read an article in the NY Times that supports this crazy idea that the guy who flew the jet into a mountain a few weeks ago suffered from depression. The Times article does a great disservice to people everywhere who have depression and suicidal thoughts. The article focuses on the guy's history of mental health treatment and so on, all of which I assume is true. But what journalists and others fail to grasp is that a person has to have a certain level of sociopathy, or more to the point, psychopathy,  to choose to end his life while murdering 149 other people. While there may be a certain number of suicidal people who may impulusively drive their car into another car or something of that sort, generally speaking, people who kill themselves are only interested in harming themselves, not others. People who fly passenger planes with people on board into mountains are after something more than their own deaths. It may be notoriety or fame or attention or whatever. Psychopaths kill because they can. They live their lives outside the normal assumptions and rules that govern most people's lives. Whether he was depressed is far less important than the reality that he was very likely a dangerous person, bent on doing something awful.

I don't think airlines have the tools to differentiate between normal depression and a potentially dangerous person. To not recognize the difference between the two in the aftermath of a terrible incident like this one and to paint this bad guy with the same descriptive brush as a person with clinical depression, only serves to feed our ignorance and fear of people with treatable mental illness. We don't yet know how to detect the psychopaths among us. They are usually pretty good at masking their real intentions and fooling the people around them. This guy probably left clues that were ignored that might have gotten him caught before this happened. We don't know and probably never will. But please read with great skepticism newspaper accounts that call this guy "depressed". I spent my career as a mental health therapist. I know from depression. People who I have worked with deserve way way better than to be lumped in the same category as this murderer.

Laughin' and cryin' with Sherman Alexie, Waneen and Barb

So here is the rest of the story that ended with me and Waneen reading Sherman Alexie aloud in North Bend, Washington:

In 1976, Steven was needing to transfer to the University of Idaho in order to finish up his degree.  So I went searching for a job and eventually found a job with the residence life program at Washington State University, which is 8 miles west of Moscow, Idaho, where the University of Idaho is located.  That is where I met my friend, Barbara  (I have two friends named Barbara, one of whom is alive and well and living in Spokane). Barbara was the Associate Director of Residence Life.  I was hired as a Head Resident, which meant that Steve and I lived in a high rise women's dorm with 350 screaming, hormonally unbalanced 18-20 year old young women. How we survived this situation, I shall never know. We were pretty young too at the time, so that helped

  Barbara became my fast and good friend almost immediately.  She was a full on feminist, a thinker, a reader, a lover of music.  And she was a fantastic cook.  I became a part of a little women's community of friends.  Those were great days, except maybe for the crazy  young women, nuttier guys, elevator rides, drunken parties and other charms of dorm life in the mid 70's. Steven was 24-25, I was 27-28 these years.  One of our favorite memories of this time was the Miss Va Va Va Voom story.  One day there was a knock on our door and Steve answered.  There stood the most luscious, gorgeous college Freshman the world has ever beheld.  And she says, "There's something wrong with one of the washers downstairs.  Could you get it fixed?" Steve replies, "Uh, uh, uh, uh, ...okay". He did manage to keep from drooling, which under the circumstances was a good thing.  So we named her Miss Va Va Va Voom and have never forgotten her.  

Well, two years pass and Residence Life decides that they need to get supervisors for the Head Residents, who can supervise everything more closely.  So I applied for the job and got it.  Another person who applied and took the job, site unseen, was my friend, Waneen.  She and I met on a grassy hillside one late summer day.  I said to her, and I swear this to be true, "You and I are going to be lifelong friends." Here it is 47 years down the road and I'll be darned if that little prediction hasn't held up. Waneen became good friends with Barbara as well and life continued apace for another two years.  I remember long dinners and longer talks with Barbara, Waneen and myself.  I remember glasses of wine and breakfasts at the Biscuitroot Park or the Hotel Moscow.  I remember dinners at the most fabulous restaurant in Pullman called the Seasons.  It was this little house up on a hill in downtown Pullman.  It was chef owned and operated and served the best food in the world.  It really may have been world class cuisine.  I remember Waneen, Barbara, me and several other women going to the San Juan Islands to go to a workshop put on by Anne Wilson Sheaf, who at the time was a big feminist writer and lecturer.  At the time she was in the process of writing Women's Reality, which became really kind of central to my emerging self. I remember, I remember, I remember...

But life being life, in 1980 we all went our separate ways.  Barbara went back to Delaware, where she had been before coming to Pullman.  Waneen started on her journey that took her all over the world first as a Peace Corps volunteer, then as a trainer for the Peace Corps, then as a country director then on to other countries and places for the next 20 years.  Steve and I moved to Portland, where I started graduate school at Portland State University.  Barbara and I stayed in touch.  In fact she came to visit me in Portland the first year I was there.  But as the years went by, our contact diminished as both of our lives took on different trajectories.  

Until 1995.  By then, Waneen was traveling back and forth and around and decided to visit Barbara in Delaware. Well, she found her in a mess.  This crazy thing had happened at the university where she worked.  Somehow she got caught up in some kind of crazy thing where a colleague accused her of racism. And her boss sort of threw her under the bus over this allegation.  This all came of the accuser harassing her and her responding, as I recall.  Barbara was the last person who would use race as some kind of weapon.  They called me while Waneen was there.  Waneen was very worried about her and so I invited her to come out.   She came in July of that year.  She spent about a week with me and was visibly shaken, not herself.  She was doing all the right things, going to a therapist, taking medication.  She had married, but the man was an idiot and didn't know how to support her. Her friends kind of deserted her it seemed like.  She was broken.  She really was.  But at the time, I didn't really believe that.  I thought she would be okay with time.  Well, she wasn't and in September she killed herself while on suicide watch in a psychiatric hospital.  I had called her the week before and she was hysterical.  I tried to talk to her husband, but he wouldn't talk to me.  I called back again in a few days and she said she would be alright.  By then she had decided to end her life and was just waiting for the right time and way.  A few days later she was gone.  It was a classic ride up to suicide.  I was a therapist by then of course.  But I couldn't have done anything. She died while on suicide watch in a locked facility. So Barbara to find a way to make it happen. There was something about this thing that happened that took her to her knees and she just wasn't able to get up again.  I will mourn her forever.  

Well, now to the part where Waneen and I met in North Bend, near Seattle.  It was somehow the most convenient place for us to meet at the time with Waneen's work and life. She we meet up in North Bend, about 20 miles or so from Seattle.  We stayed at Steve's friend Don't house.  He was off on a Himalaya trip, so the house was ours. This was not too long after Barbara's death.  We had wanted to meet so we could have some sort of ceremony of goodbye to our beloved friend.  We did a bunch of stuff, all of which I can't totally remember. The biggest thing we did is we took these photos that I had taken of Barbara while she was visiting me in July and took them down by the waterfront in Seattle and tore them up and lit them on fire and let the ashes go into the water.  We talked and cried and carried on.  I had brought my copy of The Lone Ranger and Tonto Fist Fight in Heaven  and took to reading it aloud to Waneen each night before we went to sleep.  It really did make us laugh and cry.  Or it made me laugh and cry.  Anyway, this one night we had just turned out the light and out of nowhere the smoke alarm went off.  Well, I being of little or no use in a middle of the night, have to do something situation, just kind of ran around while Waneen got up on a chair and somehow got the thing to stop.  So we go back to bed and a little while later, I would not make this up, the faucet on the washing machine breaks off and starts gushing water all over the place.  Well, if I can't deal with a smoke alarm, you can only imagine how completely useless I am when water is gushing out all over the place.  Again, Waneen gathers herself and somehow manages to turn off the water.  It was the craziest thing ever.  We were convinced and still are that it was Barbara's spirit in there giving us shit. Saying goodbye.  Telling us to let her go. It was amazing.  Truly.  

I don't have much left of Barbara. A cookbook of her's and a recipe that I still have in my little recipe box.  I still make it every now and then. It is the original paper, in her writing. Here it is: