CHAPTER SIXTEEN. AMERICA’S BORDERLINE SPLIT

Written by: Rick Staggenborg, MD on Jul 10, 2009 7:18 AM PDT

This essay is dedicated to Glenn O. Gabbard, from whom I learned the rudiments of object relations theory, upon which this essay is based.

To become the Doctors Who Will Heal Ourselves, we must begin by studying the phenomenon of Borderline Personality Disorder. This is a psychiatric condition characterized by an unstable sense of self, others and the relationship between the two. This inability to establish a stable sense of ourselves and our relation to others results from an inability to integrate the good and bad aspects of each and leads to several problems. 

It becomes impossible to internalize the positive image of others that enables the psychologically healthy individual to tolerate their disappointing behaviors. This in turn leads to difficulty in regulating our emotions, leading to emotional instability, chronic anger and when things get really tough, a preoccupation with death and dying, even to the point of repeated suicide attempts. The knowledge of our inability to form meaningful relationships leads to a chronic sense of emptiness and frantic efforts to avoid abandonment to preserve our sense of safety and the illusion of feeling related to others.

Let us examine each of these difficulties in turn, for the incidence of borderline illness is growing at a frightening rate. When enough people suffer from this disorder of psychological development, a critical mass is achieved which leads to a disorder of society. This problem now threatens to go critical and vaporize the social order upon which democracy depends. Our Borderline Split is a major contributor to the alarming rise in the suicide rate as our social and economic crisis widens.

Before proceeding to look at the causes and consequences of this malignant threat to the psychological health of America, let us briefly consider one of its most important implications. When a borderline mentality governs society, psychopathic individuals can use their cunning charm to feign normality in order to gain powerful positions, such as chairmen of corporations. 

These psychopaths take advantage of the disordered society for their own short-term advantage, without regard to the fiduciary trust shareholders place in them or the long-term health of the corporations for which they are responsible. The proverbial hardworking American is now unable to depend on income from the corporation to securely plan her future. It is a characteristic of the psychopath to act self-destructively and without regard to the well being of others. 

It is important that psychopathy be distinguished from the much more common condition of antisocial personality disorder. While both have similar effects on society, the antisocial individual acts impulsively out of anger, with little consideration of the effects of his behavior on himself as well as others. This leads to self destruction as well as harm to others. Antisocial personality arises from the same traumas that typically create borderline personalities, while psychopaths seem to lack then neurological mechanism which allows the internal mirroring of the emotional experience of others that normally leads to empathy. 

The psychopath takes pains not to harm himself, not realizing that his behavior sows the seeds of self-destruction.  In a world in which we are all interdependent physically and emotionally, the law of Karma is absolute. At this time in history the actions of a small few are putting the survival of human civilization at risk, and they will not be spared the consequences of their unbridled selfishness. 

It is as if psychopaths were emotionless Vulcans learning to blend in with humans through the study of their behavior. Unlike the Vulcans of Roddenbury’s vision in Star Trek, psychopaths have no consideration of the long term effects of their actions on society or themselves. They are thus, in Spock’s way of thinking, illogical. 

In fact, emotion is an integral part of perception and cognition. Life would not be comprehensible without it because if all experiences were perceived objectively, none would have any importance beyond those which directly cause pain or pleasure. Rational thought about intangible things we call values would not be possible if we could not distinguish between pleasurable and painful emotions evoked by our interactions with each other and the world. Those who lack empathy are thus in a very real sense mentally ill.

Our unstable sense of self can be considered to arise from one or both of two experiences in our early development: lack of adequate nurturing or abuse. With the experience of sufficient caring or (God willing) love, we can develop the emotional resiliency needed to recover if we experience these things in later life, though this is often prevented by our own disordered and self destructive behavior. If we lack this caring altogether and experience only abuse and neglect, our prognosis is much graver and requires more intensive treatment to recover.

Fostering a sense of security and psychological stability requires extraordinary patience on the part of the doctor or therapist, as well as a deep awareness of her own psychological weaknesses and triggers to anger. That is the challenge we face if we are going to become healers in a world that is critically ill. It seems superhuman to remain compassionate for people who are harming others through their ignorance and greed, yet that is what we must do for the healing to take place.

When the treating clinician succumbs to his own narcissistic need for gratification from the progress of the patient and becomes impatient, frustrated or disapproving of the patient’s continuing self destructive behavior, he fails to put the patient’s needs before his own and guarantees that treatment will fail. He will thus be further frustrated by his inability to heal the patient. Only through developing the objectivity and patience to consistently provide unconditional positive regard for the patient is there hope for her recovery.

When borderline patients begin to experience this consistent acceptance and unconditional positive regard, they will almost invariably begin to develop the fragile sense of trust necessary to develop a stable sense of self, others and their relationship to each other. They remain exquisitely sensitive to the behavior of the loved object and any perceived inconsistency on the part of the therapist leads to therapeutic setbacks. If this occurs repeatedly trust is lost, along with any hope for psychological healing. The corollary in society is that the breakdown in civility we have witnessed threatens the psychological health of Americans and the mutual positive regard for each other upon which democracy depends.

Establishing emotional stability is a more difficult task, but one which is essential to the healing process. All higher organisms are hard-wired to react to severe or physical or even psychological pain as a threat to survival. As both physical and psychological pain are experienced in the mind rather than the body, the result is the formation of mental schemata that ascribe to the external world negative qualities that prompt avoidant responses to the everyday hurts we all experience.

Fortunately, we have evolved a frontal lobe which can make sense of our experience, allowing us to correct these cognitive distortions. This remarkable organ also allows us to regulate the intensity of our emotional responses, an essential component of our ability to maintain our reason in the face of psychological threats or real threats tour physical integrity. 

The psychologically healthy individual and society itself thus can come to realize that there is always hope and reason to survive and to overcome these threats and the causes of our emotional distress. Herein lies the hope for the cure of social ills and the survival of the species and the elimination of the so-called Thanatos, Freud’s erroneously assumed death impulse.

When we have all helped others to reach this state of psychological health and emotional security of our well-being, we will have achieved the collective consciousness of our interdependence and a rational basis for a consistent sense of safety. 

We can lose our individual and collective sense of emptiness and psychological isolation if we begin to respond to the commonalities that make us human rather than the differences that artificially divide us. This will ease the frenzy to establish unstable loving relationships that are typical for the borderline individual, for such relationships  will then be accepted by all as normal and expected. This will enable America and people everywhere to have the sense of purpose and direction that will enable us to find the way to avoid self-destruction.

Soldiers For Peace, you now understand the objectives of this war and the importance of your mission. As the war has already begun, you are compelled to go into the world and develop the tactics to win this war for the survival of humanity. If we do not act in anger but with a calm, shared sense of our duty, victory is assured.

In the words of Yusuf Islam (Cat  Stevens):

She hangs her head and, cries on my shirt.

She must be hurt very badly.

Tell me what's making you sadly?

Open your door, don't hide in the dark

You're lost in the dark, you can trust me.

'Cause you know that's how it must be

Lisa Lisa, sad Lisa Lisa.

Her eyes like windows, tricklin' rain

upon her pain getting deeper,

though my love wants to relieve her.

She walks alone from wall to wall.

Lost in a hall, she can't hear me!

Though I know she likes to be near me.

Lisa Lisa, sad Lisa Lisa.

She sits in a corner, by the door.

There must be more I can tell her.

If she really wants me to help her,

I'll do what I can to show her the way.

And maybe one day I will free her,

Though I know no one can see her,

Lisa Lisa, sad Lisa Lisa.

Rick Staggenborg, MD

Coos Bay, OR