Borderline Personality Disorder: A Conversation with M. Gerard Fromm, PhD, ABPP
What do you suppose is happening for the suffering person, under the skin?
I would argue that the fear of abandonment is absolutely key, and that it's that fear that provokes so much instability in work life and, especially, in personal life. Usually when people break out into something called borderline, their sense of themselves in relationships tends to have a deep contradiction. They simultaneously feel that they are way too much for another person - that no one can stand the intensity of their feelings or the idiosyncrasies of their inner life - but also that they're not enough. They feel a weakened sense of self. They're dependent on another person's presence to avoid isolation and abandonment, and yet they feel they're not enough to hold the other person with them, and then that their anxiety-driven emotions will drive away the person they most need. It’s an impossible spot.
In short, they’re terrified of being left alone. Just terrified. And when that comes up, they can become easily enraged, and frantic to do something about it. It's such a terror that they don't actually allow the feeling to happen. It's so hard to sit with this feeling. In some ways, to feel lonely is an advance for this kind of person, because it allows them to tolerate aloneness without feeling overwhelmed. Our effort in treatment is to help people sit with painful feelings and learn to tolerate them without feeling it is the end of the world. In these frightened states, there's no time frame, everything is now. It is a revelation for a person to see it's not always going to feel this way, feelings are feelings, they do not condemn a person to a permanent and terrible fate.
And they pass rather quickly if one lets them?
That's right, though the relationship issues that lead to the bad feelings need to be grasped and changed. The Lacanians talk about three orders of experience: First, real order: the raw, emotional experience that borders on actual trauma. Second, the imaginary order: for the person in the borderline spot, they feel attuned to one other person and they are in heaven in that brief moment when they can talk themselves into the illusion that the other person will always be with them, and they are in hell when that falls apart. That is a kind of imaginary bubble the person is constantly caught up in. And third, there is the symbolic order: everyday laws, roles, and language, putting things into a perspective that includes a reality larger than both people and that situates the person in an ordinary understanding of how people work. That stage is very hard for a person in this borderline state to get to, so in the midst of a breakdown moment of such intense experience, you see behavior that feels so outrageous, so apart from ordinary ways people might operate that it tips you off that an extreme condition is in front of you. In a state like this, the person seems shameless, but when it's over, the sense of reality returns and, along with it, a deep sense of shame.
This six-part series, exploring borderline personality disorder, is taken from an interview, conducted by former Erikson Scholar Joshua Wolf Shenk in 2009, with M. Gerard Fromm, PhD, ABPP, a senior consultant to the Erikson Institute for Education and Research at the Austen Riggs Center.