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

CHAPTER NINETY SEVEN. HEALING AMERICA’S BORDERLINE SPLIT

Written by: Rick Staggenborg, MD on Jun 28, 2010 2:15 PM PDT

This chapter is dedicated to James Kohut, who developed much of the Object Relations model that is the framework by which I came to understand the pathogenesis and treatment of Borderline Personality spectrum conditions.
In America's Borderline Split I explored the parallels between borderline personality disorder in individuals and a similar disorder that has come to plague the American collective consciousness. This essay describes what must be done to cure that collective dysfunction so that Americans can come to control their individual and collective destinies by creating a truly democratic society.

America is nearly paralyzed by the inability of the average American to see beyond our superficial differences and think of ourselves as one People. We are all Americans and by extension, citizens of the Earth. We stand at the crossroads between a future that could be Heaven on Earth or, following the road we are on, one that holds multiple threats to the survival of human civilization and leads to Hell on Earth. Soon, we must decide individually and collectively whether we will continue marching down the road toward the dead end of American Empire or forge a new path toward a future of peace, love and understanding where the survivalist mentality is but a historical curiosity.

Borderline personality pathology is caused by the inability to integrate into one coherent image the positive and negative aspects of our experience of others. We internalize these experiences as representations of the people who are responsible for teaching us with love to regulate our emotions, delay gratification, accept responsibility for our actions and generally to mature into psychologically healthy and responsible adults.

As infants, we do not perceive ourselves to be separate from our environment. Early in life, we begin to associate positive and negative mood states with the persons around us who seem to induce them by their actions. This is the earliest representation of the not-self, or the Object in Object Relations theory.

If we experience love consistently from our parents, they become “good” objects. If our parents are consistently loving in their interactions with us, it is easy to maintain a positive regard for them even when they inflict pain, such as in teaching us to respect others by making us apologize when we do not. This is emotionally upsetting to the child, but a necessary lesson for living in an interdependent and civil society.

When parents are inconsistent, neglectful or consistently angry or punitive, the child is unable to form a consistent image of the Other as loving. They may see the Other as represented by the internalized parent: Threatening, unpredictable and untrustworthy. While other adults can sometimes provide the consistent affection children need to experience in order to learn to soothe themselves when upset, most children reared in such circumstances fail to achieve adequate integration of the ”good’ and “bad” Objects that are the representations of the positive and negative experiences we have of our caregivers.

As adults, these products of dysfunctional homes tend to form snap judgments of others and are quick to label as “bad” those whose ideas seem different and therefore threatening. This reflexive fear of the other leads to isolation and fear of change, the hallmarks of non-rational conservatism. Other self-identified conservatives are afraid of rapid change, but only seek to change the system slowly and cautiously.

Unfortunately, the corporatists who have seized our government have no such compunctions. In historical time, they have moved very rapidly to assume control of the government through simultaneous attack on the free media, the Supreme Court selection process, the electoral process, international diplomacy and regulation of business. In this time of crisis, traditional conservative responses to the excesses carried out in the name of “conservatism” are inadequate. To Take Back America for the People, we must finish the Revolution that the neo-cons have so thoroughly subverted. The insurgents responsible for the international terrorism since the coup in Iran in 1951 must be stopped now. If we do not act collectively and soon, we may lose the opportunity to restore democracy to the United States that we surrendered in the corporate coup over the last 30 years.

Because parents are rarely totally consistent and because we mature at different rates, some aspects of Borderline psychopathology persist into adulthood for most of us and if we grow up in an emotionally abusive or neglectful home, the pathology is worse and can be very resistant to change. If expressions of love are inconsistent they acquire a powerful value, bonding the child to its aggressor even more strongly than a consistent pattern of loving by the parent. In psychological terms, this is called an intermittent reinforcement schedule and its result identification with the aggressor.

The attitudes and emotions we develop during childhood toward our parents generalize toward others in our later life. Thus, if I believe my parents are unloving and only concerned for themselves, I am likely to expect that of others and treat them accordingly. The predictable effect of automatically distrusting others is that I will not be trusted to consider their interests. If I am such a person, I will only respond to kindness, because it is so unexpected that it challenges my preconceptions and forces me to think. 

The task of those of us raised in loving homes is to recognize that our experience is not the norm in today's society. If we want to return to the halcyon days of our youth, we must model respectful and caring behavior to others so that they may see a more perfect society is possible. In so doing, we undo the work of the corporate media that normalizes antisocial behavior by constantly showing it and even praising the corporatists who live their lives unheeding of their social responsibilities. We must practice random acts of kindness so that others may begin to question the right of the corporate elite to run our government like a candy store that only they are allowed to buy from.

Those who fail to appreciate the importance of their early life experiences do not know themselves, so cannot be true to themselves. They are easily led into rationalizing their antisocial actions when convinced that it is in their best interests or that “that is the way it is.” The truth is that each of us lives in our own reality, filtering our experiences of the day through the lens of our personality.

If we choose to believe that nothing can be done to create a more just economy, government or society we create a self-fulfilling prophesy of the world to come. All it takes for evil to succeed is for good men and women to conclude that nothing can be done but to pray for someone else to save them from the consequences of their own greed, apathy or intellectual laziness. Neither Jesus nor Mohammad will not do it, for God only helps those who help themselves. We have few leaders in the Senate who are morally fit ot make decisions on behalf of all of us. We must work together to replace them with ones who are.

A society where individual responsibility is felt to be the most important virtue is not a healthy one. The radical individualist fails to recognize that just as each of us is interdependent on each other, society and government to enjoy the blessings of democracy, we are interdependent economically. It is the winner-take-all mentality that has caused the economy and society to self-destruct. It is natural for multigenerational abuse and neglect to increase over time in such a society.

If it were true that individuals are always responsible for taking care of themselves and their families with no regard to the effects of their attitudes or actions on society as a whole, then it follows that once these abused children grow up, it is up to them to fix themselves and to make it in the world without any help from family or the government that we all pay for. I do not choose to accept this model of society and do not believe that democracy can long survive the increasingly prevalence of this selfish belief system.

The fallacies in this radically individualistic life-view are apparent on casual inspection. Clearly, it is not a morally defensible position to say that each of us is fully responsible for our own fate. We determine collectively whether the least among us will have an opportunity equal to the favored few to succeed in making it in a mercilessly competitive society. We have to therefore accept individual and collective responsibility for the suffering of those who have been disadvantaged by the society we have created. Accepting responsibility means accepting our own responsibility to the poor, the emotionally damaged, the sick, the old and all of the most defenseless among us who suffer through no fault of their own.

My progressive friends cannot understand why people who more often than not call themselves “Christian” cannot see the simple truth that we are responsible for the welfare of the least among us, as Christ simply stated. It is impossible to argue that greed is good and that unregulated capitalism is the best way to run a democratic society. We knew this at our nation’s founding, when the Founders risked death to establish the credo that “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain inalienable rights, that among them are the rights to Life, Liberty and the Pursuit of Happiness…” In a society where selfishness is lauded as a virtue, clearly such rights are not universal. Inevitably, this craven competition for ever more wealth and status leads to poverty, disease, hunger, mental illness, despair and individual and societal suicide.

Fortunately, modern Psychology has proven that personality traits once thought to be unchangeable can be treated and with proper care, altered such that the individual becomes happier and more functional both individually and as a member of society. It is not too late to provide the parenting to the angry black-and-white thinkers who have actively encouraged psychopaths in government and industry to lead us ever closer to the edge of outright fascism. They can still grow up to lead happy and productive lives if we can take the responsibility of teaching them the importance of treating others as equals and equally deserving of our love as better behaved children are.

It is unreasonable to expect that these frequently abused and neglected men and women will simply change because we tell them that they are wrong and it borders on insanity to think they will listen if we simply try to outshout the Tea Partiers. We must all reach within ourselves and use the love that we have been blessed with to soothe our own anger and approach these broken souls with loving concern. We arrived at this moment together and none of us is blameless for the resulting situation. The Borderline mind thinks only in terms of Black and White, Good and Bad, Me versus You and cannot even keep its emotional response to an idea straight, being led to feel one way or the other by the skillful emotional manipulation of the corporate media and many of our politicians. That said, the right wing does not have a monopoly on emotional reasoning. We must also hold self-identified “progressives” to this standard when they lose sight of the rights of individuals in a free society.

Those of us who can control our emotional responses to ignorance, greed, apathy, injustice and even cruelty are few in number. We need to think hard about how we can best become the teachers Who Will Change the World. It is our responsibility to encourage those who clearly have the capability to reason based on facts and not emotion to develop the self discipline to help us face the tormentors of the weak without fear of provoking further anger and attack by these seemingly hopelessly confused tools of the right wing. They are our brothers and sisters too, our fellow Americans and fellow citizens of the world.

We are all more alike than otherwise. It is our commonalities that define us as human and our differences that provide the spice to life. Each of us is a part of the Eternal One and we are all equally deserving of the love of a benevolent God. If we do not forget this then we can become the generation that becomes The Doctors Who Will Heal Ourselves.

In the immortal words of Bill Withers:




Sometimes in our lives we all have pain,
we all have sorrow.
But, if we are wise
we know that there's always tomorrow.


Lean on me, when you're not strong
and I'll be your friend,
I'll help you carry on.
For it won't be long
'til I'm gonna need
somebody to lean on.


Please swallow your pride
if I have things you need to borrow.
For no one can fill those of your needs
that you don't let show.


Lean on me, when you're not strong
and I'll be your friend,
I'll help you carry on.
For it won't be long
'til I'm gonna need
somebody to lean on.


If there is a load you have to bear
that you can't carry,
I'm right up the road.
I'll share your load
if you just call me.


So just call on me brother, when you need a hand.
We all need somebody to lean on.
I just might have a problem that you'd understand.
We all need somebody to lean on.


Lean on me when you're not strong
and I'll be your friend,
I'll help you carry on.
For it won't be long
‘till I'm gonna need
somebody to lean on.




Lean on me...






Rick Staggenborg, MD


Detroit, Michigan