Walking the Line: Borderline States in Context
Borderline Personality Disorder is a 20th Century construct although one with resonances to earlier diagnoses such as ‘hysteria’. In the 21st Century, the DSM 5 decision to make Personality Disorder and “Axis 1” disorder adds weight to its recognition as a medical disorder. Arguably this has moral implications with respect to the duty to treat. In this talk BPD will be considered with attention to the contexts in which BPD is more likely to develop. The question will be raised as to whether the construct can be understood as a ‘within-the-individual’ phenomenon. From the perspective of the Conversational Model, BPD reflects a disorder of self often related to traumatic impingement and neglect in early life. Dissociation is often a prominent feature and needs to be considered in assessment. Effective treatment requires engagement with self in addition to the processing of the trauma. The conditions required for growth of self will be discussed.
The complexity of ‘borderline states’ will be discussed from a philosophical perspective with reference to two books, Reinterpreting the Borderline (Paul Cammell) and Mapping the edges and the in-between (Nancy Nyquist Potter). Particular attention will be paid to the idea that the anger of people in ‘borderline states’ needs to be given uptake (Potter). Clinicians sometimes walk a fine line in providing containment while encouraging full expression of the patient’s experience.
