Many Mental Health workers use a manual called the DSM-IV to help diagnose clients or patients. This manual separates the various mental "illnesses" into categories. I have an MSW (Masters of Social Work) and have a DSM-IV somewhere on my bookshelf at the church office. The categories provide diagnostic criteria such as symptoms and length of time symptoms have manifested as well as frequency. Many mental "illnesses" have an organic nature. The cause of the illnesses has to do with either a genetic imbalance (such as Down's Syndrome) or a chemical imbalance. Chemical imbalances can cause a wide variety of complications from psychosis at one extreme to mild or severe depression on the other. Chemical imbalances can be helped, with the right medication and good therapy many people can live normal lives. Personality Disorders are another matter.
Personality Disorders such as Borderline and Narcissistic are not organic. These "illnesses" are caused by a trauma experienced in childhood around the age of 2-4 years old. Now, not everyone who has experienced a trauma at that age will develop a personality disorder. But some do. The trauma needs to be severe enough, perhaps frequent enough, to impact the fragile developing psyche of the child. In essence the trauma is usually inflicted by a parent or a someone deeply trusted by the child. The trauma, physical or psychological abuse, is so extreme that the child shuts down. The impact is so severe that the child cannot reconcile the child's self to the abuse that is happening. A defensive mechanism with in the child develops. In the Borderline it manifests as an inability to hear anything even slightly perceived as "critical" of the self. When the person thinks they are being criticised they "split" they disengage from the moment, they shut down. Then they turn the blame onto the other person - that person becomes the evil one, the mean one, the hateful one, the abusive one.
Think about it. We all have a difficult time being "criticised." No one likes to feel inadequate. All of us have defenses to help us cope with the situation. But most of us are also able to be reflective, to ponder the possibility that in the critique is some truth we may need to hear. The Borderline cannot do this. The Borderline is erratic, easily angered, charming, sweet, manipulative, and sees the world through very distorted lenses. The version of reality perceived by the Borderline always has some hint of truth to it, but that truth is distorted to make the Borderline OK and someone else not ok. It's a black and white process no gray...
While working on my MSW I had a professor who did group therapy with Borderlines. It was almost impossible. In fact treating Borderlines effectively is generally impossible. They don't have the stamina to look at their own behavior and take responsibility for their healing. They can't tolerate thinking that there might be anything "wrong" with them. There is no medication for a Personality Disorder because it is neither chemical nor organic. Personality Disorders are tragic because they are caused by human abuse. Or, at least that's how I understand it. The mental health world changes frequently there may be some new data that I am unaware of.
Anyway, this professor said that she had success with Borderlines in group therapy because they were able to see their own behavior in other people around them, and therefore learn. I don't know about this and I can't imagine doing group therapy with a room full of Borderlines. But then, as I've said, my mother was a Borderline, so that kind of experience would really challenge my ability to stay neutral in the therapeutic environment.
Growing up with a mother who was Borderline left me very confused. For many years I struggled to know what was real, what was truth. When I first started therapy my therapist asked me to read a book, The Drama of the Gifted Child by Alice Miller. This book began, in me, a process of understanding my life. Essentially it describes how some children suppress their own developmental process in order to support and sustain the needs of a loved one or parent. In my case I suppressed all of the usual separation and individuation process of a normal kid (I never rebelled, I always endorsed my mother's view arguing against my father and brothers and their sense of "what happened" etc.). When my mother's marriage fell apart she enrolled in the university I attended and moved into that town. My mother went to college with me. At least for a few years. So, by the time I was an adult and trying to live on my own I found that I didn't really know who I was, how I felt, or what I wanted.
Finally in my mid 20's, after ending a long relationship with a young man I met in college, I entered therapy and read that book. It was the beginning of 14 years of therapy. Long years of not only winding through my past but learning to live my present. And the majority of the healing in me did not really happen until my mother moved in with me in 1992 (see previous post) after my son was born. It was that experience, having her back in my daily life after a 7 year break, and her efforts to have things be as they always had been, which pushed me over the edge. I returned to therapy. My therapist even met my mother.
It was my mothers idea. She wanted to meet my therapist so she could tell her all about me. My therapist was totally open to the idea. I was terrified. I was certain that once my therapist met my mother it would be all over. The therapist would see my mothers version of reality and my version would cease to exist. Thankfully my therapist and I could talk about my fear, and she reassured me that that would not happen. In fact it was the opposite. My therapist helped me understand that my mother was fragile and damaged and incapable of seeing the world any other way. Not that her reality was the whole truth, but it was her reality. And mine was mine.
It seems almost silly now. But of course. Still in those early years of learning to be me, of be able to recognize my own feelings, sort them out, and articulate them as mine, there remained a deep fear of being lost once again in my mother's world.
Over the years I have lived with deep shame and fear about my mother being borderline. I have worried that because she was I would be too. I have even known psychiatrists who will say as much, "Borderlines raise Borderlines." Slowly I have come to share my story, to tell a few folks about my mother. Some of my colleagues and friends are people who work in the mental health world, they have worked with Borderlines. They mirror back to me that I am not.
After a long hiatus I returned to therapy a year and half ago. This time I did not track down the woman who helped me so much in those first 14 years of therapy. I wanted something else. I found a Jungian. Who is also an Episcopal priest. And a man.
So, my therapy is taking a new approach these days. For example: my first therapist once asked me if there had been any constant stable adult in my life? I could not think of a single person. We moved too much and grew apart from the extended family. And neither of my parents were stable. My thought, which went unexpressed, was, God. God was the one constant in my life. With this Jungian priest we can talk about that. Because I do think that I survived my childhood with some inner sense of stability and hope because I lived with faith in God, and I prayed daily. The other thing about this work I am doing know is that it reinforces my decisions and decision making process. I am able to process what I am thinking and feeling and have someone say back, yes. that's right. So. I'm learning to trust myself at an even deeper level. Now I think I am healed from the effects of my childhood, I know who I am, how I feel, and what I need to do. I can trust my version of reality.