Here are some notes from a patient I treated at a Psychiatric Hospital in the 1990’s. “Becky” (not her real name) had a preexisting diagnosis of Borderline Personality Disorder and “frequented” the psych wing I was assigned to at the time. The following is my best guesswork as to how Becky’s early developmental experiences coalesced to form the constellation of symptoms requiring a diagnosis of Borderline Personality Disorder: Becky self-reports that at an early age, her mother started confiding in her about things that are inappropriate for her age. The patient stated that her mother was also abusive physically and mentally towards her in her childhood. She was forced into the role of her mother’s confidant—a process we refer to as becoming “parentified.” Researchers believe that borderline personality disorder results from a combination of individual vulnerability to environmental stress, neglect or abuse as young children, and a series of events that trigger the onset of the disorder as young adults. Environmental and genetic factors play a role in the development of the borderline personality disorder. Becky described her childhood as “turbulent” and unhappy. She craved attention mostly from her mother who was unable to meet Becky’s needs and caused Becky increasing discomfort, confusion and a declining sense of self-esteem and worth. According to Becky, her mother describing how she “suffered sexually” and it makes sense that Becky was picking up on the mother’s cues for Becky to be her therapist or friend versus young, impressionable child. Becky discussed sex with mom because it worked to get the mother’s attention, concern and sympathy. This negative attention set Becky along a negative trajectory of manipulating others to meet her unmet emotional needs by telling lies, acting out and bizarre behavior. “The type of early family environment that is seen to contribute to Borderline Personality Disorder is called, "the invalidating environment." An invalidating environment is described by the following examples: • If a child reports that he is hungry he is told that he is not hungry, he just ate. I.e. his inner experience is invalidated. • When a child expresses upset, the family does not pay attention, or tells him he's making a big deal about it. • The child's beliefs, thoughts and preferences and ideas are not sought or taken seriously. • The child's emotions are not considered to be important communications and are not responded to or do not results in the child's needs getting met. • The child is blamed for her painful experiences and such experiences are trivialized. • The child is discriminated against based on arbitrary characteristics such as gender. • Punishment is used to control behavior, from criticism up to physical and sexual abuse. A history of sexual abuse is seen in approximately 75% of people with Borderline Personality Disorder, according to Marsha Linehan” (Linehan, 1993). The following are my private notes and supporting details for using the therapeutic intervention I chose while treating Becky: The appropriate short-term goals for Becky’s intervention include a plan to help make the daily, minute-to-minute, living of life manageable. She is no different than a blind person in world of sight. She needs constant, emotional-grounding to find her way through the literal, emotional blackness in her life. Due to her “special needs,” her genetically based inability to process the emotions of others, emotional-navigating is treacherous and pock-marked with heartache. As the blind person uneasily, grasps for furniture, doors, and walls seeking to constantly evaluate and avoid danger; Becky grasps for an emotional guide to help her navigate the emotional landscape she cannot clearly interpret and historically misinterprets. Becky has no bearings, no compass and no understanding of the very landscape that makes humans uniquely human. She is the animal equivalent of a featherless, flightless bird or a turtle with no shell. To the untrained eye, the acquaintance, co-worker, and classmate, she does not present with an obvious handicap and so Becky strives to keep them at bay. She tightly clings with a death-grip to her family who is all too aware of Becky’s shortcomings. I want to empower Becky to act appropriately in her environment and with the people in it. Becky’s tendency to exaggerate at any cost is taxing on her family, rightfully so. A pathological need for attention drives Becky to crave the never-ending attention and feedback from her family for reassurance. Growing up, she was unable to correctly assess her relationships with all social cues unable to find the correct neural pathways to register their existence. The depth, meaning and passion of spoken feelings by her family were all completely lost on her and strong attachments and bonds would never live in her heart. Becky distrusted everyone as a result of her biologically based inability to properly gauge and respond in kind to the stimuli. Her inability to correctly read people and their intentions constantly threw her off balance and caused her to attempt to overindulge in feelings that she knew others had a handle on yet escaped her own grasp. She wanted to feel what they felt and think how they thought and love like she saw them love. She was disoriented as a human without basic feelings of humanity. Becky wanted to experience what they all claimed to feel for one another and for her as well but she lacked the brain chemistry to get in touch with her emotions. She needed escalating reassurance and guidance which turned into her doubting her own abilities to function “normally” like everyone else. The result was she could never be reassured enough and became increasingly demanding to her family members. Genetically deprived of her most basic right to be a human capable of loving deeply, she spun out of control. The self-loathing and mutilation Becky experiences should begin to diminish with a blueprint for right living through right thinking. Leading a life of integrity and shoring up her porous boundaries will bring rewards to Becky such as increased self-confidence and worth. With a map to right living she will short circuit her brain’s default mode (Amygdala hijack of the frontal cortices) which historically leads Becky on an unhappy course. Therapies designed to help Borderline Personality sufferers is instrumental to helping sort out internal wrong-information from reality-based facts. I want Becky to begin the therapeutic process of Mentalization, which is specifically meant to help people like Becky overcome their inefficient and dysfunctional ways of compensating or coping with their inability to process or regulate emotion. My goal is to help Becky correctly interpret the cues and meaning that occur during socialization so she can act accordingly and respond appropriately. Immediately, I want to put Becky on a course of “acting herself into right thinking.” As soon as possible I want Becky to adopt the following four remedies in all her affairs so that she can reap the rewards of right-living, kind and thoughtful actions all the while acting decently, decidedly, and courageously. A “BE IMPECCABLE WITH YOUR WORD Speak with integrity. Say only what you mean. Avoid using words to speak against yourself or to gossip about others. Use the power of your word in the direction of truth and love. B DON'T TAKE ANYTHING PERSONALLY Nothing others do is because of you. What others say and do is a projection of their own reality, their own dream. When you are immune to the opinions and actions of others, you won't be the victim of needless suffering. C DON'T MAKE ASSUMPTIONS Find the courage to ask questions and to express what you really want. Communicate with others as clearly as you can to avoid misunderstandings, sadness and drama. With just this one agreement, you can completely transform your life. D. ALWAYS DO YOUR BEST Your best is going to change from moment to moment; it will be different when you are healthy as opposed to sick. Under any circumstance, simply do your best and you will avoid self-judgment, self-abuse and regret (Ruiz, 1997).
