For centuries, European society excluded people regarded as “insane” from normal life, confining them to asylums or driving them from one town to another. By the 18th century, a few doctors were beginning to study the people in asylums, and discovered that some of these patients had, by no means, lost the powers of reason: they had a normal grasp of what was real and what wasn’t, but they suffered terribly from emotional anguish through their impulsiveness, ragefulness, and a general difficulty in self-governance caused others to suffer. They seemed to live in a borderland between outright insanity and normal behaviour and feeling.
These people, who were neither insane nor mentally healthy, continued to puzzle psychiatrists for the next one hundred years. It was in this “borderland” that society and psychiatry came to place its criminals, alcoholics, suicidal people, emotionally unstable and behaviourally unpredictable people—to separate them off both from those with more clearly defined psychiatric illnesses at one border (those, for example, whose illness we have come to call schizophrenia and manic-depressive or “bipolar” disorder) and from “normal” people at the other border.
About a hundred years ago, a bright but very ill young woman found that if her doctor listened to her for hours while she told him about her inner experience and her memories, the symptoms that were making her life unbearable would gradually subside. The patient recovered and went on to become the first social worker in Germany.
Her doctor, Dr. Breuer, went on to become one of the teachers of Sigmund Freud, inventor of the “talking cure” — psychoanalysis. At first the students of Freud thought that the talking cure would help all mentally ill people except those who were seriously psychotic. But over the years they found themselves dealing with some patients who were in the same “borderland” described before: people who were not psychotic, but who did not respond to the talking cure in the way the therapists expected. Gradually, therapists began to define this “borderline” group not so much by their symptoms as by the special problems that were underneath the symptoms, and by the effects these people had upon others.
The symptoms of borderline patients are similar to those for which most people seek psychiatric help: depression, mood swings, the use and abuse of drugs, alcohol, or food as a means of trying to feel better; obsessions, phobias, feelings of emptiness and loneliness, inability to tolerate being alone.
In addition, these patients displayed great difficulties in controlling ragefulness; they were unusually impulsive, they fell in and out of love suddenly; they tended to idealize other people and then abruptly despise them. A consequence of all this was that they typically looked for help from a therapist and then suddenly quit in terrible disappointment and anger.
Underneath all these symptoms, therapists began to see in borderline people an inability to tolerate the levels of anxiety, frustration, rejection and loss that most people are able to put up with, an inability to soothe and comfort themselves when they become upset, and an inability to control the impulses toward the expression, through action, of love and hate that most people are able to hold in check. What seems to be of central importance in the symptoms and difficulties mentioned above is that the hallmark of the “borderline” personality is great difficulty in holding on to a stable, consistent sense of one’s self: “What am I?” these people ask. “My life is in chaos; sometimes I feel like I can do anything—other times I want to die because I feel so incompetent, helpless and loathsome. I’m a lot of different people instead of being just one person.”
The one word that best characterizes borderline personality is “instability.” Emotions are unstable, fluctuating wildly, often for no discernible reason. Thought processes are unstable—rational and clear at times, quite extreme and distorted at other times. Behaviour is unstable—often with periods of excellent conduct, high efficiency and trustworthiness alternating with outbreaks of regression to childlike states of helplessness and anger, suddenly quitting a job, withdrawing into isolation, failing.
Self control is unstable leading to impulsive behaviours and chaotic relationships. A person with borderline personality disorder may sacrifice themselves for others, only to reach their limit and suddenly fly into rageful reproaches, or they may curry favour through obedient submission only to rebel, out of the blue, in a tantrum.
Associated with this instability is terrible anxiety, guilt and self-loathing for which relief is sought at any cost—medicine, drugs, alcohol, overeating, suicide. Sadly, oddly, self-injury is discovered bymany borderline people to provide faster relief than anything else—cutting or burning themselves stops the anxiety temporarily.
The effect upon others of all this trouble is profound: family members never know what to expect from their volatile child, siblings, or spouse, except they know they can expect trouble: suicide threats and attempts, self-inflicted injuries, outbursts of rage and recrimination, impulsive marriages, divorces, pregnancies and abortions; repeated starting and stopping of jobs and school careers, and a pervasive sense, on the part of the family, of being unable to help.
And, of course, the effect of the illness upon the life of the patient is equally profound: jobs are lost, successes are spoiled, relationships shattered, families alienated. The end result is all too often the failure of a promising life, or a tragic suicide.
The above information was obtained from: